Savio G Barreto1,2,3, Mark E Brooke-Smith1,3,4, Eu Ling Neo1,3,4, Paul Dolan3,4, Richard Leibbrandt2, Tim Emery5, Robert Carroll6,7, Alan Wigg2,3,8, John W Chen9,10,11,12. 1. Hepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia. 2. College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. 3. South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia. 4. HPB Surgery Unit, The Royal Adelaide Hospital, Adelaide, South Australia, Australia. 5. South Australian Transplantation & Immunogenetics Service, Australian Red Cross Blood Service, Adelaide, South Australia, Australia. 6. Department of Renal Medicine, The Royal Adelaide Hospital, Adelaide, South Australia, Australia. 7. School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia. 8. Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, South Australia, Australia. 9. Hepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia. john.chen@flinders.edu.au. 10. College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. john.chen@flinders.edu.au. 11. South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia. john.chen@flinders.edu.au. 12. HPB Surgery Unit, The Royal Adelaide Hospital, Adelaide, South Australia, Australia. john.chen@flinders.edu.au.
Abstract
BACKGROUND: There is a growing disparity between the number of liver transplant (LT) candidates and availability of suitable liver allografts. Antibody-mediated rejection (AMR), secondary to positive donor-specific antibodies (DSA), remains a concern in liver transplantation. This study aimed to correlate expression of DSA on pre-transplant screening and outcomes of LT, specifically development of AMR in liver allografts and liver function profile in the post-operative period. METHODS: Data of consecutive patients undergoing orthotopic LT (OLT) at the South Australian Liver Transplant Unit was analysed. All patients underwent DSA testing pre-transplant. RESULTS: Within a cohort of 96 patients, over a post-OLT median follow-up of 849 days, only 2 patients (2%) developed AMR. While both patients had a positive DSA test preoperatively, overall DSA positivity was noted in 31% patients, with a specificity for prediction of AMR of 0.708. No significant association was noted between AMR (p = 0.092), T cell-mediated rejection/TCMR (p = 0.797) or late hepatic artery thrombosis/LHAT (p = 0.521). There was no significant interaction effect between DSA positivity and serum bilirubin or transaminases over a period of 100 days. CONCLUSION: AMR following LT is uncommon. A positive DSA pre-transplant does not imply a definite risk of AMR. Also, there does not exist a significant interaction in time between DSA expression and serum bilirubin or transaminase levels. Until there emerges evidence to the contrary, it appears reasonable to consider DSA-positive donors within the broad context of marginal donors in the context of a worldwide shortage of LT donor allografts.
BACKGROUND: There is a growing disparity between the number of liver transplant (LT) candidates and availability of suitable liver allografts. Antibody-mediated rejection (AMR), secondary to positive donor-specific antibodies (DSA), remains a concern in liver transplantation. This study aimed to correlate expression of DSA on pre-transplant screening and outcomes of LT, specifically development of AMR in liver allografts and liver function profile in the post-operative period. METHODS: Data of consecutive patients undergoing orthotopic LT (OLT) at the South Australian Liver Transplant Unit was analysed. All patients underwent DSA testing pre-transplant. RESULTS: Within a cohort of 96 patients, over a post-OLT median follow-up of 849 days, only 2 patients (2%) developed AMR. While both patients had a positive DSA test preoperatively, overall DSA positivity was noted in 31% patients, with a specificity for prediction of AMR of 0.708. No significant association was noted between AMR (p = 0.092), T cell-mediated rejection/TCMR (p = 0.797) or late hepatic artery thrombosis/LHAT (p = 0.521). There was no significant interaction effect between DSA positivity and serum bilirubin or transaminases over a period of 100 days. CONCLUSION: AMR following LT is uncommon. A positive DSA pre-transplant does not imply a definite risk of AMR. Also, there does not exist a significant interaction in time between DSA expression and serum bilirubin or transaminase levels. Until there emerges evidence to the contrary, it appears reasonable to consider DSA-positive donors within the broad context of marginal donors in the context of a worldwide shortage of LT donor allografts.
Authors: Banu Sis; Gian S Jhangri; Sakarn Bunnag; Kara Allanach; Bruce Kaplan; Philip F Halloran Journal: Am J Transplant Date: 2009-07-22 Impact factor: 8.086
Authors: Bobby V M Dasari; Andrea Schlegel; Hynek Mergental; M Thamara P R Perera Journal: Best Pract Res Clin Gastroenterol Date: 2017-04-12 Impact factor: 3.043
Authors: A Casavilla; C Ramirez; R Shapiro; D Nghiem; K Miracle; O Bronsther; P Randhawa; B Broznick; J J Fung; T Starzl Journal: Transplantation Date: 1995-01-27 Impact factor: 4.939