Arianna Barbetta1, Glenda Meeberg2, Brittany Rocque1, Sarah Barhouma3, Carly Weaver4, Susan Gilmour2, Farah Faytrouni5, Orlee Guttman5, Shannon Zielsdorf1,3,4, Kambiz Etesami1,3,4, Yong Kwon1,3,4, George Yanni3,6, Patricia Campbell2,7, James Shapiro2, Juliet Emamaullee1,3,4. 1. Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA. 2. Alberta Transplant Institute, Edmonton, Alberta, Canada. 3. University of Southern California, Los Angeles, California, USA. 4. Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children's Hospital-Los Angeles, Los Angeles, California, USA. 5. Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada. 6. Department of Pediatrics, Children's Hospital-Los Angeles, Los Angeles, California, USA. 7. Departemtent of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada.
Abstract
BACKGROUND: Pediatric liver transplant (LT) recipients of maternal living liver donor (LLD) grafts have been reported to experience fewer rejection episodes. However, it is unclear whether this benefit translates to reduction in developing donor-specific antibody (DSA) among maternal-LLD recipients. The aim of this study was to compare immunologic outcomes among maternal-LLD, non-maternal-LLD, and deceased donor liver transplant (DDLT) recipients. METHODS: Children (≤18 years) who underwent LT between 1/1998 and 12/2019 at two high-volume LT centers in North America were evaluated. Patients were divided into three groups by type of graft received (maternal-LLD, non-maternal LLD, and DDLT). Clinical variables and outcomes were compared according to each graft type. RESULTS: A total of 450 pediatric primary LT were analyzed: 275 (61.1%) DDLT, 73 (16.2%) maternal-LLD, and 102 (22.6%) non-maternal-LLD. Children receiving LLD grafts were less likely to develop rejection when compared to the DDLT group (DDLT 46.9% vs. maternal-LLD 31.5% vs. non-maternal-LLD 28.4%, p = 0.001). There was no difference in rejection rates between maternal and non-maternal-LLD recipients. A higher percentage of maternal-LLD recipients were on immunosuppression monotherapy compared to non-maternal-LLD and DDLT recipients (6.7% vs. 1.2 vs. 2.4%, respectively). A subgroup of 68 patients were tested for DSA post-LT. Maternal-LLD recipients were less likely to develop de novo DSA (maternal-LLD 11.8% vs. non-maternal-LLD 19.3% vs. DDLT 43%, p = 0.018). None of the maternal-LLD recipients developed antibody-mediated rejection. CONCLUSIONS: These data support the concept of immunologic benefit of maternal-LLD in pediatric LT, with lower rates of rejection and allosensitization post-LT when compared to DDLT recipients.
BACKGROUND: Pediatric liver transplant (LT) recipients of maternal living liver donor (LLD) grafts have been reported to experience fewer rejection episodes. However, it is unclear whether this benefit translates to reduction in developing donor-specific antibody (DSA) among maternal-LLD recipients. The aim of this study was to compare immunologic outcomes among maternal-LLD, non-maternal-LLD, and deceased donor liver transplant (DDLT) recipients. METHODS: Children (≤18 years) who underwent LT between 1/1998 and 12/2019 at two high-volume LT centers in North America were evaluated. Patients were divided into three groups by type of graft received (maternal-LLD, non-maternal LLD, and DDLT). Clinical variables and outcomes were compared according to each graft type. RESULTS: A total of 450 pediatric primary LT were analyzed: 275 (61.1%) DDLT, 73 (16.2%) maternal-LLD, and 102 (22.6%) non-maternal-LLD. Children receiving LLD grafts were less likely to develop rejection when compared to the DDLT group (DDLT 46.9% vs. maternal-LLD 31.5% vs. non-maternal-LLD 28.4%, p = 0.001). There was no difference in rejection rates between maternal and non-maternal-LLD recipients. A higher percentage of maternal-LLD recipients were on immunosuppression monotherapy compared to non-maternal-LLD and DDLT recipients (6.7% vs. 1.2 vs. 2.4%, respectively). A subgroup of 68 patients were tested for DSA post-LT. Maternal-LLD recipients were less likely to develop de novo DSA (maternal-LLD 11.8% vs. non-maternal-LLD 19.3% vs. DDLT 43%, p = 0.018). None of the maternal-LLD recipients developed antibody-mediated rejection. CONCLUSIONS: These data support the concept of immunologic benefit of maternal-LLD in pediatric LT, with lower rates of rejection and allosensitization post-LT when compared to DDLT recipients.
Authors: Eric M Przybyszewski; Elizabeth C Verna; Steven J Lobritto; Mercedes Martinez; Jennifer M Vittorio; Alyson N Fox; Benjamin Samstein; Tomoaki Kato; Adam D Griesemer; Jean C Emond Journal: Transplantation Date: 2018-06 Impact factor: 4.939
Authors: Sandy Feng; John C Bucuvalas; George V Mazariegos; John C Magee; Alberto Sanchez-Fueyo; Katharine M Spain; Andrew Lesniak; Sai Kanaparthi; Emily Perito; Veena L Venkat; Bryna E Burrell; Estella M Alonso; Nancy D Bridges; Edward Doo; Nitika A Gupta; Ryan W Himes; David Ikle; Annette M Jackson; Steven J Lobritto; Juan Jose Lozano; Mercedes Martinez; Vicky L Ng; Elizabeth B Rand; Averell H Sherker; Shikha S Sundaram; Yumirle P Turmelle; Michele Wood-Trageser; Anthony J Demetris Journal: Hepatology Date: 2021-05 Impact factor: 17.425
Authors: Angus Hann; Daniel-Clement Osei-Bordom; Desley A H Neil; Vincenzo Ronca; Suz Warner; M Thamara P R Perera Journal: Front Immunol Date: 2020-06-22 Impact factor: 7.561