Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.
Am J Transplant. 2014 Apr;14(4):779-87. doi: 10.1111/ajt.12667. Epub 2014 Mar 1.
The impact of donor-specific HLA alloantibodies (DSA) on short- and long-term liver transplant outcome is not clearly defined. While it is clear that not all levels of allosensitization produce overt clinical injury, and that liver allografts possess some degree of alloantibody resistance, alloantibody-mediated adverse consequences are increasingly being recognized. To better define the current state of this topic, we assembled experts to provide insights, explore controversies and develop recommendations for future research on the consequences of DSA in liver transplantation. This article summarizes the proceedings of this inaugural meeting. Several insights emerged. Acute antibody-mediated rejection (AMR), although rarely diagnosed, is increasingly understood to overlap with T cell-mediated rejection. Isolated liver allograft recipients are at increased risk of early allograft immunologic injury when preformed DSA are high titer and persist posttransplantation. Persons who undergo simultaneous liver-kidney transplantation are at risk of renal AMR when Class II DSA persist posttransplantation. Other under-appreciated DSA associations include ductopenia and fibrosis, plasma cell hepatitis, biliary strictures and accelerated fibrosis associated with recurrent liver disease. Standardized DSA testing and diagnostic criteria for both acute and chronic AMR are needed to distil existing associations into etiological processes in order to develop responsive therapeutic strategies.
供者特异性 HLA 同种抗体（DSA）对肝移植短期和长期预后的影响尚不清楚。虽然很明显，并非所有同种致敏水平都会产生明显的临床损伤，而且肝移植物具有一定程度的同种抗体抗性，但同种抗体介导的不良后果越来越受到关注。为了更好地定义这一主题的现状，我们召集了专家，就 DSA 在肝移植中的后果提供见解，探讨争议并为未来的研究提出建议。本文总结了这次首次会议的会议记录。有几个观点出现了。急性抗体介导的排斥反应（AMR），尽管很少被诊断，但越来越被认为与 T 细胞介导的排斥反应重叠。当预先形成的 DSA 高滴度并在移植后持续存在时，孤立的肝移植受者发生早期同种异体免疫损伤的风险增加。当 Class II DSA 在移植后持续存在时，同时进行肝肾移植的人有发生肾 AMR 的风险。其他未被充分认识的 DSA 相关因素包括胆管减少症和纤维化、浆细胞性肝炎、胆管狭窄和与复发性肝病相关的加速纤维化。需要标准化的 DSA 检测和急性及慢性 AMR 的诊断标准，将现有关联提炼为病因过程，以便制定有反应的治疗策略。
