title: Prevalence, incidence and risk factors for donor-specific anti-HLA antibodies in maintenance liver transplant patients.
abstract: Although large retrospective studies have identified the presence of donor-specific antibodies (DSAs) to be a risk factor for rejection and impaired survival after liver transplantation, the long-term predicted pathogenic potential of individual DSAs after liver transplantation remains unclear. We investigated the incidence, prevalence and consequences of DSAs in maintenance liver transplant (LT) recipients. Two hundred sixty-seven LT recipients, who had undergone transplantation at least 6 months previously and had been screened for DSAs at least twice using single-antigen bead technology, were included and tested annually for the presence of DSAs. At a median of 51 months (min-max: 6-220) after an LT, 13% of patients had DSAs. At a median of 36.5 months (min-max: 2-45) after the first screening, 9% of patients have developed de novo DSAs. The sole predictive factor for the emergence of de novo DSAs was retransplantation (OR 3.75; 95% CI 1.28-11.05, p = 0.025). Five out of 21 patients with de novo DSAs (23.8%) developed an antibody-mediated rejection. Fibrosis score was higher among patients with DSAs. In conclusion, monitoring for the development of DSAs in maintenance LT patients is useful in case of graft dysfunction and to identify patients with a high risk of developing liver fibrosis.
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France; Université Paul Sabatier, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Del Bello
authors.forename: N
authors.initials: N
authors.lastname: Congy-Jolivet
authors.forename: F
authors.initials: F
authors.lastname: Muscari
authors.forename: L
authors.initials: L
authors.lastname: Lavayssière
authors.forename: L
authors.initials: L
authors.lastname: Esposito
authors.forename: I
authors.initials: I
authors.lastname: Cardeau-Desangles
authors.forename: J
authors.initials: J
authors.lastname: Guitard
authors.forename: G
authors.initials: G
authors.lastname: Dörr
authors.forename: B
authors.initials: B
authors.lastname: Suc
authors.forename: J P
authors.initials: JP
authors.lastname: Duffas
authors.forename: L
authors.initials: L
authors.lastname: Alric
authors.forename: C
authors.initials: C
authors.lastname: Bureau
authors.forename: M
authors.initials: M
authors.lastname: Danjoux
authors.forename: C
authors.initials: C
authors.lastname: Guilbeau-Frugier
authors.forename: A
authors.initials: A
authors.lastname: Blancher
authors.forename: L
authors.initials: L
authors.lastname: Rostaing
authors.forename: N
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D006680:HLA Antigens / Q000097:blood* / Q000276:immunology; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000097:blood* / Q000276:immunology; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D008107:Liver Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: Donor-specific antibodies; incidence; liver transplantation; prevalence; steroid-free