title: Donor-Specific HLA Antibodies in Living Versus Deceased Donor Liver Transplant Recipients.
abstract: With less ischemia, improved donor selection and controlled procedures, living donor liver transplantation (LDLT) might lead to less HLA donor-specific antibody (DSA) formation or fewer adverse outcomes than deceased donor liver transplantation (DDLT). Using the multicenter A2ALL (Adult-to-Adult Living Donor Liver Transplantation Cohort Study) biorepository, we compared the incidence and outcomes of preformed and de novo DSAs between LDLT and DDLT. In total, 129 LDLT and 66 DDLT recipients were identified as having serial samples. The prevalence of preformed and de novo DSAs was not different between DDLT and LDLT recipients (p = 0.93). There was no association between patient survival and the timing (preformed vs. de novo), class (I vs. II) and relative levels of DSA between the groups; however, preformed DSA was associated with higher graft failure only in DDLT recipients (p = 0.01). De novo DSA was associated with graft failure regardless of liver transplant type (p = 0.005) but with rejection only in DDLT (p = 0.0001). On multivariate analysis, DSA was an independent risk factor for graft failure regardless of liver transplant type (p = 0.017, preformed; p = 0.002, de novo). In conclusion, although similar in prevalence, DSA may have more impact in DDLT than LDLT recipients. Although our findings need further validation, future research should more robustly test the effect of donor type and strategies to mitigate the impact of DSA.
authors.affiliation: Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.|Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: J
authors.initials: J
authors.lastname: Levitsky
authors.affiliation: UCLA Paul Terasaki Institute, Los Angeles, CA.
authors.forename: H
authors.initials: H
authors.lastname: Kaneku
authors.affiliation: Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: C
authors.initials: C
authors.lastname: Jie
authors.affiliation: Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: R C
authors.initials: RC
authors.lastname: Walsh
authors.affiliation: Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: M
authors.initials: M
authors.lastname: Abecassis
authors.affiliation: Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: A R
authors.initials: AR
authors.lastname: Tambur
mesh_terms: D000328:Adult; D002102:Cadaver; D002641:Chicago / Q000453:epidemiology; D015331:Cohort Studies; D046148:Donor Selection; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D015994:Incidence; D007518:Isoantibodies / Q000276:immunology*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D066027:Transplant Recipients
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: alloantibody; antibody biology; clinical research/practice; histocompatibility; immunobiology; liver allograft function/dysfunction; liver transplantation/hepatology; liver transplantation: living donor; rejection; translational research/science