Impact of Donor-Specific Antibodies on Graft Fibrosis After Pediatric Living Donor Liver Transplantation for Biliary Atresia.
BACKGROUND
Pediatric living donor liver transplant (LDLT) patients sometimes develop graft fibrosis after non-recurrent diseases such as biliary atresia (BA). Donor-specific antibodies (DSA) have recently been shown to play a possible role in graft damage after liver transplantation. We report the impact of DSA on pediatric LDLT for BA patients.


METHODS
Patients under age 18 years who received LDLT for BA at our institution and who had at least 5 years' follow-up were identified, and 23 were eventually enrolled in this study. Pathological findings were assessed with the use of the last available biopsy. Patients were divided into 2 groups, DSA-positive and DSA-negative. Graft fibrosis after LDLT was assessed according to DSA groups.


RESULTS
The mean patient age at transplant was 2.6 years. The mean time to the last available biopsy after LDLT was 8.2 years (4.8-15.6 years); 6 patients (26%) showed no fibrosis, whereas fibrosis was graded as F1, F2, or F3 in 8 patients (35%), 8 patients (35%), and 1 patient, respectively. DSA were observed in 12 patients (52%). Moderate graft fibrosis (F2 and F3) was found in 7 (58%) of the DSA-positive group, but only 2 (18%) of the DSA-negative group, showing a statistically significant difference (P < .05). Pre-transplant cross-matching was performed in 17 patients. The 2 patients with a positive cross-match were DSA-positive. Six cross-match-negative patients developed de novo DSA after LDLT.


CONCLUSIONS
Graft fibrosis was observed after LDLT for BA during long-term follow-up, more commonly in DSA-positive patients. DSA may play a role in fibrosis formation.
Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: ueno@pedsurg.med.osaka-u.ac.jp.
T
T
Ueno
Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
M
M
Zenitani
Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
H
H
Yamanaka
Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
N
N
Tanaka
Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
S
S
Uehara
Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Y
Y
Tazuke
Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan.
K
K
Bessho
Pediatric Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
H
H
Okuyama
D000293:Adolescent; D000906:Antibodies / Q000378:metabolism*; D001656:Biliary Atresia / Q000378:metabolism / Q000601:surgery*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000378:metabolism; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
D000906:Antibodies; D006680:HLA Antigens