Donor-Specific Anti-HLA Antibodies and Endothelial C4d Deposition—Association With Chronic Liver Allograft Failure
| Autor: | Arnold Radtke, Falko M. Heinemann, Monika Lindemann, Hideo A. Baba, Speranta Iacob, Iyad Kabar, Susanne Beckebaum, Hartmut Schmidt, Gernot M. Kaiser, Vito R. Cicinnati |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Liver Cirrhosis Male Time Factors Allograft failure Biopsy medicine.medical_treatment Medizin Liver transplantation Immune system HLA Antigens Isoantibodies Predictive Value of Tests Risk Factors Immunity Complement C4b Humans Medicine Hla antibodies Prospective Studies Treatment Failure Prospective cohort study Transplantation medicine.diagnostic_test business.industry Endothelial Cells Middle Aged Immunohistochemistry Peptide Fragments Immunity Humoral Liver Transplantation Cross-Sectional Studies surgical procedures operative Liver Immunology Female business Biomarkers |
| Zdroj: | Transplantation. 99:1869-1875 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000000613 |
| Popis: | The significance of humoral immune response for allograft survival after liver transplantation (LT) is still a matter of debate. The aim of this cross-sectional study was to assess immunological and clinical factors associated with advanced fibrosis (F3-F4) and chronic graft failure in LT recipients.Serum samples from 174 patients prospectively enrolled and followed up for 12 months were tested for anti-HLA antibodies and compared against donor HLA types. Immunohistochemical C4d staining was performed on formalin-fixed, paraffin-embedded liver tissue.Mean time period from LT to enrollment was 66.9 ± 51.9 months. Independent predictive factors for graft failure included donor-positive cytomegalovirus serostatus (P = 0.02), donor-specific antibodies (DSA) against HLA class II (P = 0.03), donor age (P = 0.01), hepatitis C virus allograft reinfection (P = 0.0008), and biliary complications (P = 0.003). HLA class II DSA and HLA class I antibody positivity, hepatitis C virus reinfection, and mycophenolate mofetil-free regimens were significant risk factors for advanced fibrosis after LT. There was a significant association between C4d deposition on allograft endothelial cells and presence of class II DSA (P0.0001). Patients with C4d deposits had a 4.3 times higher risk of graft failure than those with negative staining and a significantly lower median time to graft failure (94.6 months [range, 3.6-158.9 months] vs 176.4 months [range, 9.4-217.8 months], P0.0001).Screening for HLA DSA might be useful for early identification of LT recipients at increased risk of graft failure who could benefit from closer surveillance and tailored immunosuppressive regimens. |
| Databáze: | OpenAIRE |
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