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Preformed donor‐specific antibodies are associated with 90‐day mortality in living‐donor liver transplantation
Author(s) -
Tamura Kei,
Tohyama Taiji,
Watanabe Jota,
Nakamura Taro,
Ueno Yoshitomo,
Inoue Hitoshi,
Honjo Masahiko,
Sakamoto Katsunori,
Takai Akihiro,
Ogawa Kohei,
Takada Yasutsugu
Publication year - 2019
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13352
Subject(s) - medicine , gastroenterology , univariate analysis , antibody , donor specific antibodies , liver transplantation , incidence (geometry) , transplantation , human leukocyte antigen , living donor liver transplantation , surgery , antigen , immunology , multivariate analysis , kidney transplantation , physics , optics
Aim The impact of donor‐specific anti‐human leukocyte antigen (HLA) antibodies (DSAs) on living donor liver transplantation (LDLT) is unclear. The aim of this study was to investigate the association between DSAs and short‐term outcomes in LDLT recipients, and to clarify the clinical impact of DSAs. Method Anti‐HLA antibodies were screened in preoperative serum samples taken from 40 liver transplant recipients at Ehime University (Toon, Japan) between August 2001 and July 2015. Screening was carried out using the Flow‐PRA method, and DSAs were detected in anti‐HLA antibody‐positive recipients using the Luminex single‐antigen identification test. A mean fluorescence intensity of 1000 was used as the cut‐off for positivity. We retrospectively reviewed the clinical courses of patients who were DSA‐positive to elucidate early clinical manifestations in LDLT recipients. Results Fifteen (12 female and 3 male) patients (38%) had anti‐HLA antibodies. Eight of the 15 anti‐HLA antibody‐positive patients were positive for DSAs, and all were women. The 90‐day survival rate of DSA‐positive patients (50%) was significantly lower than that of DSA‐negative patients (84.4%) (0.0112; Wilcoxon test). On univariate analysis, the DSA‐positive rate was significantly higher in the 90‐day mortality group. Postoperatively, the incidence of acute cellular rejection was higher in DSA‐positive than DSA‐negative patients. Thrombotic microangiopathy developed only in DSA‐positive patients. We found no relationship between DSA status and bile duct stricture. Conclusion Preformed DSAs could be associated with elevated 90‐day mortality in LDLT recipients. Further large‐scale studies are required to verify the risk associated with DSAs in LDLT.