De Novo Donor-Specific HLA Antibodies Decrease Patient and Graft Survival in Liver Transplant Recipients

被引:235
作者
Kaneku, H. [1 ]
O'Leary, J. G. [2 ]
Banuelos, N. [3 ]
Jennings, L. W. [2 ]
Susskind, B. M. [2 ]
Klintmalm, G. B. [2 ]
Terasaki, P. I. [1 ,3 ]
机构
[1] Univ Calif Los Angeles, Los Angeles, CA 90095 USA
[2] Baylor Univ, Med Ctr, Annette C & Harold C Simmons Transplant Inst, Dallas, TX USA
[3] Terasaki Fdn Lab, Los Angeles, CA USA
关键词
Allograft rejection; de novo donor-specific HLA antibodies; graft survival; liver transplantation; patient survival; risk factors; HUMAN-LEUKOCYTE ANTIGEN; POSITIVE CROSS-MATCH; CHRONIC REJECTION; MEDIATED REJECTION; KIDNEY-TRANSPLANTATION; HUMORAL REJECTION; FOLLOW-UP; ALLOGRAFTS; EXPRESSION; INDUCTION;
D O I
10.1111/ajt.12212
中图分类号
R61 [外科手术学];
学科分类号
摘要
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.
引用
收藏
页码:1541 / 1548
页数:8
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