title: Impact of donor-specific antibodies on results of liver transplantation.
abstract: OBJECTIVE
  To critically examine the recent literature evaluating the importance of HLA donor-specific antibody (DSA) impact on liver transplant and simultaneous liver-kidney transplant (SLKT) outcomes.
  
  
  RESULTS
  Many preformed DSAs, especially of low mean fluorescence intensity (MFI), are absorbed by the liver at transplant. However, patients with post-liver transplant DSA, especially of higher MFI, are at increased risk of acute and chronic rejection. C4d staining, when positive, may be helpful but lacks sensitivity especially in formalin tissue. SLKT recipients may need close follow-up when class II DSA is found, as the liver protects the kidney from hyperacute rejection, but can still cause early renal antibody-mediated rejection, liver allograft rejection, and impair patient, liver allograft, and renal allograft survival.
  
  
  CONCLUSIONS
  Some DSAs are relevant in liver transplant and can lead to acute and chronic allograft rejection. However, before clinical practice patterns can change we must create unified diagnostic criteria, define the pathologic potential of different DSAs, and improve the specificity of current testing.
authors.affiliation: Annette C. & Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas 75246, USA. Jacquelo@BaylorHealth.edu
authors.forename: Jacqueline G
authors.initials: JG
authors.lastname: O'Leary
authors.forename: Göran B
authors.initials: GB
authors.lastname: Klintmalm
mesh_terms: D001323:Autoantibodies / Q000276:immunology*; D015935:Complement C4b / Q000276:immunology; D006085:Graft Survival / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology*; D010446:Peptide Fragments / Q000276:immunology; D014019:Tissue Donors
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d