Exploring pre-surgery donor-specific antibodies in the context of organ shortage in liver transplant.

Autor: Barreto SG; Hepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia., Brooke-Smith ME; Hepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.; South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.; HPB Surgery Unit, The Royal Adelaide Hospital, Adelaide, South Australia, Australia., Neo EL; Hepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.; South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.; HPB Surgery Unit, The Royal Adelaide Hospital, Adelaide, South Australia, Australia., Dolan P; South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.; HPB Surgery Unit, The Royal Adelaide Hospital, Adelaide, South Australia, Australia., Leibbrandt R; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia., Emery T; South Australian Transplantation & Immunogenetics Service, Australian Red Cross Blood Service, Adelaide, South Australia, Australia., Carroll R; Department of Renal Medicine, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.; School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia., Wigg A; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.; South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.; Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, South Australia, Australia., Chen JW; Hepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia. john.chen@flinders.edu.au.; College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. john.chen@flinders.edu.au.; South Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia. john.chen@flinders.edu.au.; HPB Surgery Unit, The Royal Adelaide Hospital, Adelaide, South Australia, Australia. john.chen@flinders.edu.au.
Jazyk: angličtina
Zdroj: Langenbeck's archives of surgery [Langenbecks Arch Surg] 2019 Nov; Vol. 404 (7), pp. 865-874. Date of Electronic Publication: 2019 Nov 20.
DOI: 10.1007/s00423-019-01831-9
Abstrakt: Background: There is a growing disparity between the number of liver transplant (LT) candidates and availability of suitable liver allografts. Antibody-mediated rejection (AMR), secondary to positive donor-specific antibodies (DSA), remains a concern in liver transplantation. This study aimed to correlate expression of DSA on pre-transplant screening and outcomes of LT, specifically development of AMR in liver allografts and liver function profile in the post-operative period.
Methods: Data of consecutive patients undergoing orthotopic LT (OLT) at the South Australian Liver Transplant Unit was analysed. All patients underwent DSA testing pre-transplant.
Results: Within a cohort of 96 patients, over a post-OLT median follow-up of 849 days, only 2 patients (2%) developed AMR. While both patients had a positive DSA test preoperatively, overall DSA positivity was noted in 31% patients, with a specificity for prediction of AMR of 0.708. No significant association was noted between AMR (p = 0.092), T cell-mediated rejection/TCMR (p = 0.797) or late hepatic artery thrombosis/LHAT (p = 0.521). There was no significant interaction effect between DSA positivity and serum bilirubin or transaminases over a period of 100 days.
Conclusion: AMR following LT is uncommon. A positive DSA pre-transplant does not imply a definite risk of AMR. Also, there does not exist a significant interaction in time between DSA expression and serum bilirubin or transaminase levels. Until there emerges evidence to the contrary, it appears reasonable to consider DSA-positive donors within the broad context of marginal donors in the context of a worldwide shortage of LT donor allografts.
Databáze: MEDLINE
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