De novo donor-specific HLA antibodies decrease patient and graft survival in liver transplant recipients

H. Kaneku, J. G. O'Leary, N. Banuelos, L. W. Jennings, B. M. Susskind, G. B. Klintmalm, P. I. Terasaki

Research output: Contribution to journalArticlepeer-review

213 Scopus citations

Abstract

The role of de novo donor-specific HLA antibodies (DSA) in liver transplantation remains unknown as most of the previous studies have only focused on preformed HLA antibodies. To understand the significance of de novo DSA, we designed a retrospective cohort study of 749 adult liver transplant recipients with pre- and posttransplant serum samples that were analyzed for DSA. We found that 8.1% of patients developed de novo DSA 1 year after transplant; almost all de novo DSAs were against HLA class II antigens, and the majority were against DQ antigens. In multivariable modeling, the use of cyclosporine (as opposed to tacrolimus) and low calcineurin inhibitor levels increased the risk of de novo DSA formation, while a calculated MELD score >15 at transplant and recipient age >60 years old reduced the risk. Multivariable analysis also demonstrated that patients with de novo DSA at 1-year had significantly lower patient and graft survival. In conclusion, we demonstrate that de novo DSA development after liver transplantation is an independent risk factor for patient death and graft loss. This single-center retrospective cohort study assesses the development of de novo donor-specific HLA antibodies at one year after liver transplantation and finds that the presence of these antibodies is an independent risk factor for patient death and graft loss.

Original languageEnglish (US)
Pages (from-to)1541-1548
Number of pages8
JournalAmerican Journal of Transplantation
Volume13
Issue number6
DOIs
StatePublished - Jun 2013

Keywords

  • Allograft rejection
  • de novo donor-specific HLA antibodies
  • graft survival
  • liver transplantation
  • patient survival
  • risk factors

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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