title: Donor-specific antibodies and liver transplantation.
abstract: In contrast to other types of organ transplantation, liver-transplant recipients used to be considered highly resistant to donor-specific antibodies (DSAs). Consequently, most transplant programs did not consider the presence of DSAs at transplantation or during the follow-up. However, since the early 1990s, antibody-mediated pathological lesions have been recognized in ABO-incompatible liver-transplant recipients. Recent data confirm the detrimental effect of preformed and de novo DSAs in ABO-compatible liver transplantation, with inferior clinical outcomes in patients presenting with circulating antibodies. Acute antibody-mediated rejection (AMR), plasma-cell hepatitis, biliary stricture, but also long-term complications, such as chronic rejection, liver ductopenia, and graft fibrosis, are now recognized to be associated with DSAs. Moreover, some non-HLA DSAs are suspected to induce graft dysfunction. Clinical, biological, and histological patterns within AMR need to be clarified. Treatment of these complications has yet to be defined. This article summarizes recent advances concerning the impact of preformed and de novo DSAs in liver transplantation, it defines the complications associated with DSAs, and discusses the potential strategies to manage patients with such complications.
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France; Université Paul Sabatier, Toulouse, France. Electronic address: delbello.a@chu-toulouse.fr.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Del Bello
authors.affiliation: Université Paul Sabatier, Toulouse, France; Molecular Immunogenetics Laboratory, EA 3034, Faculté de Médecine Purpan, IFR150 (INSERM), France; Department of Immunology, Hôpital de Rangueil, CHU de Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Congy-Jolivet
authors.affiliation: Department of Pathology, CHU Purpan, Toulouse, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Danjoux
authors.affiliation: Université Paul Sabatier, Toulouse, France; Department of Surgery and Liver Transplantation, Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France; Université Paul Sabatier, Toulouse, France; INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000920:Antibody-Dependent Cell Cytotoxicity; D006084:Graft Rejection / Q000276:immunology*; D006680:HLA Antigens / Q000276:immunology; D006801:Humans; D056724:Immunity, Humoral; D007518:Isoantibodies / Q000378:metabolism*; D016031:Liver Transplantation; D009928:Organ Specificity; D014181:Transplantation Immunology
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: Antibody-mediated rejection; Donor-specific antibodies; Humoral response; Liver transplantation; Treatment