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Comparative Study
. 2013 Jun;13(6):1541-8.
doi: 10.1002/ajt.12212.

De novo donor-specific HLA antibodies decrease patient and graft survival in liver transplant recipients

H Kaneku  1 , J G O'Leary, N Banuelos, L W Jennings, B M Susskind, G B Klintmalm, P I Terasaki
Affiliations
Comparative Study

De novo donor-specific HLA antibodies decrease patient and graft survival in liver transplant recipients

H Kaneku et al. Am J Transplant. 2013 Jun.

Abstract

The role of de novo donor-specific HLA antibodies (DSA) in liver transplantation remains unknown as most of the previous studies have only focused on preformed HLA antibodies. To understand the significance of de novo DSA, we designed a retrospective cohort study of 749 adult liver transplant recipients with pre- and posttransplant serum samples that were analyzed for DSA. We found that 8.1% of patients developed de novo DSA 1 year after transplant; almost all de novo DSAs were against HLA class II antigens, and the majority were against DQ antigens. In multivariable modeling, the use of cyclosporine (as opposed to tacrolimus) and low calcineurin inhibitor levels increased the risk of de novo DSA formation, while a calculated MELD score >15 at transplant and recipient age >60 years old reduced the risk. Multivariable analysis also demonstrated that patients with de novo DSA at 1-year had significantly lower patient and graft survival. In conclusion, we demonstrate that de novo DSA development after liver transplantation is an independent risk factor for patient death and graft loss.

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Conflict of interest statement

Disclosure

The authors have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Frequency of locus-specific de novo DSA according to HLA mismatches. (A) Frequency of de novo DSA by HLA locus. The number in parenthesis indicates the number of patients with mismatches to the corresponding locus. The table shows the p-values comparing the frequency of DSA in different HLA loci. (B) Frequency of de novo DSA by the number of HLA mismatches to each HLA locus.
Figure 2
Figure 2
Five-year patient and graft survival by the presence of de novo DSA. Patient (A) and graft survival (B) curves are shown from the time of transplant.
See this image and copyright information in PMC

References

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