title: Preformed antibodies detected by cytotoxic assay or multibead array decrease liver allograft survival: role of human leukocyte antigen compatibility.
abstract: The significance of human leukocyte antigen (HLA) compatibility and preformed antibodies in liver transplantation remains unclear. The objectives of this study were to evaluate, in a single-center cohort comprising 896 liver transplants, whether the degree of donor-recipient compatibility and preformed antibodies modified graft survival. Univariate Kaplan-Meier analysis demonstrated that donor-recipient HLA compatibility had a marginal impact on allograft survival. As for compatibility at individual antigen loci, 2 mismatches at HLA-A conferred a survival advantage in retransplanted allografts (P = 0.011). HLA-B and HLA-DR loci did not play a significant role in outcome in any pathology. The concordance of results on preformed antibodies detected by complement-dependent cytotoxicity (CDC) and a multiple bead assay (Luminex xMAP) showed a strong correlation between both techniques (P < 0.0001). Both CDC-detected and Luminex-detected antibodies were associated with shorter graft survival within the first year post-transplant (P = 0.01 and P = 0.016, respectively). Positive CDC T crossmatches and Luminex-detected HLA class II antibodies played a significant role in decreasing graft survival (P = 0.043 and P = 0.0019 at 1 year, respectively, and P = 0.005 and P = 0.038 at 5 years, respectively). A correlation was also observed between the presence of preformed Luminex-detected class II or Luminex I and II antibodies and allograft rejection (P = 0.001 and P = 0.042, respectively). In conclusion, although HLA typing is not a prerequisite for transplantation, screening of HLA antibodies with Luminex techniques and CDC crossmatch may be useful in the detection of at-risk patients that could benefit from increased surveillance and tailored therapy following transplantation.
authors.affiliation: Department of Immunology, Hospital Doce de Octubre, Madrid, Spain. mcastillo.hdoc@salud.madrid.org
authors.forename: Marcela
authors.initials: M
authors.lastname: Castillo-Rama
authors.forename: Maria Jose
authors.initials: MJ
authors.lastname: Castro
authors.forename: Ivan
authors.initials: I
authors.lastname: Bernardo
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Meneu-Diaz
authors.forename: Almudena Moreno
authors.initials: AM
authors.lastname: Elola-Olaso
authors.forename: Sara M
authors.initials: SM
authors.lastname: Calleja-Antolin
authors.forename: Eva
authors.initials: E
authors.lastname: Romo
authors.forename: Pablo
authors.initials: P
authors.lastname: Morales
authors.forename: Enrique
authors.initials: E
authors.lastname: Moreno
authors.forename: Estela
authors.initials: E
authors.lastname: Paz-Artal
mesh_terms: D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology*; D002648:Child; D015331:Cohort Studies; D003602:Cytotoxicity, Immunologic; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017093:Liver Failure / Q000276:immunology / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology*; D012189:Retrospective Studies; D014184:Transplantation, Homologous / Q000276:immunology
chemical_list: D006680:HLA Antigens; D007166:Immunosuppressive Agents