title: Long-term Clinical Relevance of De Novo Donor-Specific Antibodies After Pediatric Liver Transplantation.
abstract: BACKGROUND
  Anti-HLA antibodies and especially donor-specific antibodies (DSA) play a significant role in graft survival after solid organ transplantation. Their impact on long-term survival in adult liver transplantation (LT) is controversial, but they may be a risk factor. The effects of DSA after pediatric LT are still unclear.
  
  
  METHODS
  We performed a retrospective evaluation of DSA in sera from 43 children who had received transplants at our tertiary center. Twenty-four patients had good long-term clinical and laboratory graft function (group 1), whereas 19 LT recipients suffered from histologically confirmed and clinically relevant chronic allograft rejection (group 2); 16 of these have already undergone retransplantation due to graft dysfunction. Inclusion criteria were availability of sera before the first LT to identify preformed antibodies in case of DSA positivity after LT and long-term follow-up at our institution. Sera were analyzed for anti-HLA antibodies using Luminex single antigen beads, where a mean fluorescence intensity value of more than 1500 was considered positive.
  
  
  RESULTS
  The prevalence of DSA was 33% for group 1 and 68% for group 2. Antibodies were predominantly HLA class II. Values of mean fluorescence intensity were comparable in both groups. Only one of the DSA+ ve patients from group 1 exhibited preformed antibodies. In conclusion, pediatric patients with chronic rejection revealed a higher rate of de novo DSA, especially of HLA-class II DSA. Further studies are necessary to confirm these data with a larger pediatric cohort.
authors.affiliation: 1 Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Transplantation Center University Medical Center Hamburg-Eppendorf, Martinistrasse52, 20246 Hamburg, Germany. 2 Department of Transfusion Medicine, Transplantation Center University Medical Center Hamburg-Eppendorf, Martinistrasse52, 20246 Hamburg, Germany. 3 Pediatric Nephrology, Department of Pediatrics, Transplantation Center University Medical Center Hamburg-Eppendorf, Martinistrasse52, 20246 Hamburg, Germany. 4 Department of Hepatobiliary Surgery and Visceral Transplantation, Transplantation Center University Medical Center Hamburg-Eppendorf, Martinistrasse52, 20246 Hamburg, Germany. 5 Department of Pediatrics, University Hospital Bonn, Germany.
authors.forename: Enke
authors.initials: E
authors.lastname: Grabhorn
authors.forename: Thomas M C
authors.initials: TM
authors.lastname: Binder
authors.forename: Denise
authors.initials: D
authors.lastname: Obrecht
authors.forename: Florian
authors.initials: F
authors.lastname: Brinkert
authors.forename: Anja
authors.initials: A
authors.lastname: Lehnhardt
authors.forename: Uta
authors.initials: U
authors.lastname: Herden
authors.forename: Sven
authors.initials: S
authors.lastname: Peine
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.forename: Rainer
authors.initials: R
authors.lastname: Ganschow
authors.forename: Andrea
authors.initials: A
authors.lastname: Briem-Richter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005455:Fluorescent Antibody Technique; D005858:Germany; D006084:Graft Rejection / Q000097:blood / Q000175:diagnosis / Q000276:immunology*; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007518:Isoantibodies / Q000097:blood*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012698:Serologic Tests; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007518:Isoantibodies