title: De novo donor-specific anti-HLA antibodies mediated rejection in liver-transplant patients.
abstract: The incidence and consequences of de novo donor-specific anti-HLA antibodies (DSAs) after liver transplantation (LT) are not well known. We investigated the incidence, risk factors, and complications associated with de novo DSAs in this setting. A total of 152 de novo liver-transplant patients, without preformed anti-HLA DSAs, were tested for anti-HLA antibodies, with single-antigen bead technology, before, at transplantation, at 1, 3, 6 and 12 months after transplantation, and thereafter annually and at each time they presented with increased liver-enzyme levels until the last follow-up, that is, 34 (1.5-77) months. Twenty-one patients (14%) developed de novo DSAs. Of these, five patients had C1q-binding DSAs (24%). Younger age, low exposure to calcineurin inhibitors, and noncompliance were predictive factors for de novo DSA formation. Nine of the 21 patients (43%) with de novo DSAs experienced an acute antibody-mediated rejection (AMR). Positive C4d staining was more frequently observed in liver biopsies of patients with AMR (9/9 vs. 1/12, P < 0.0001). Eight patients received a B-cell targeting therapy, and one patient received polyclonal antibodies. Only one patient required retransplantation. Patient- and graft-survival rates did not differ between patients with and without DSAs. In conclusion, liver-transplant patients with liver abnormalities should be screened for DSAs and AMR.
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Université Paul Sabatier, Toulouse, France.
authors: Arnaud
authors: A
authors: Del Bello
authors: Université Paul Sabatier, Toulouse, France.|Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), Toulouse, France.|Department of Immunology, Hôpital de Rangueil, CHU de Toulouse, Toulouse, France.
authors: Nicolas
authors: N
authors: Congy-Jolivet
authors: Department of Pathology, CHU Purpan, Toulouse, France.
authors: Marie
authors: M
authors: Danjoux
authors: Université Paul Sabatier, Toulouse, France.|Department of Surgery and Liver Transplantation, CHU Rangueil, Toulouse, France.
authors: Fabrice
authors: F
authors: Muscari
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors: Laurence
authors: L
authors: Lavayssière
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors: Laure
authors: L
authors: Esposito
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors: Isabelle
authors: I
authors: Cardeau-Desangles
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors: Joëlle
authors: J
authors: Guitard
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Université Paul Sabatier, Toulouse, France.
authors: Gaëlle
authors: G
authors: Dörr
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors: David
authors: D
authors: Milongo
authors: Université Paul Sabatier, Toulouse, France.|Department of Surgery and Liver Transplantation, CHU Rangueil, Toulouse, France.
authors: Bertrand
authors: B
authors: Suc
authors: Department of Surgery and Liver Transplantation, CHU Rangueil, Toulouse, France.
authors: Jean Pierre
authors: JP
authors: Duffas
authors: Université Paul Sabatier, Toulouse, France.|Internal Medecine-Digestive Department, UMR 152, IRD, CHU Purpan, Toulouse, France.
authors: Laurent
authors: L
authors: Alric
authors: Université Paul Sabatier, Toulouse, France.|Department of Hepatology, Federation Digestive, CHU Purpan, Toulouse, France.
authors: Christophe
authors: C
authors: Bureau
authors: Université Paul Sabatier, Toulouse, France.|Department of Pathology, CHU Purpan, Toulouse, France.
authors: Céline
authors: C
authors: Guilbeau-Frugier
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Université Paul Sabatier, Toulouse, France.|INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors: Lionel
authors: L
authors: Rostaing
authors: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Université Paul Sabatier, Toulouse, France.|INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors: Nassim
authors: N
authors: Kamar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000918:Antibody Specificity; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology* / Q000628:therapy; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D007518:Isoantibodies / Q000097:blood*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: antibody-mediated rejection; donor-specific antibodies; incidence; liver transplantation; risk factors; treatment