title: Effect of donor-specific antibodies and panel reactive antibodies in living donor liver transplant recipients.
abstract: OBJECTIVE
  Preformed circulating donor-specific antibodies (DSAs) immunologically challenge vascular endothelium and the bile duct. However, the liver is an immune-tolerant organ and can avoid immunological challenges. This study was undertaken to analyze the effects of DSAs after adult living donor liver transplantation (LDLT).
  
  
  METHODS
  We retrospectively reviewed 219 LDLT patients' records treated at our center.
  
  
  RESULTS
  Of the 219 patients, 32 (14.6%) were DSA (+) and 187 (85.4%) were DSA (-). Class I DSAs were present in 18 patients, class II in seven patients, and both in seven patients. Seven patients (3.2%) showed DSA to HLA-A, four (1.8%) to HLA-B, seven (3.2%) to HLA-DR, and 14 (6.4%) to two or more HLAs. More DSAs were observed in female recipients than male recipients in the DSA (+) group. The DSA (+) group showed significantly higher levels of class I and II panel reactive antibody (PRA) than did the DSA (-) group. No significant intergroup differences were found between incidences of primary nonfunction, acute rejection, vascular complication, or biliary complication. There were no significant differences in graft survival rates between the two groups. However, the recipients with multiple DSAs tended to have more acute rejection episodes and events of biliary stricture and lower graft survival rates than did patients in the DSA (-) group.
  
  
  CONCLUSIONS
  In LDLT, the presence of multiple DSAs and high PRA seemed to be associated with poor graft outcomes, although our results did not reach statistical significance. Large cohort studies are necessary to clarify the impact of DSA and PRA in LDLT.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Song
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Myoung Soo
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Jung Jun
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Man Ki
authors.initials: MK
authors.lastname: Ju
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jae Geun
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Juhan
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Gi Hong
authors.initials: GH
authors.lastname: Choi
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Soon Il
authors.initials: SI
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea. ; The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Joo
keywords: Acute rejection; Donor specific antibody; Graft survival; Liver transplantation; Sensitization