San Segundo D, Alonso C, Ruiz P, Romon I, Arias-Loste M T, Cuadrado A, Puente A, Casafont F, López-Hoyos M, Crespo J, Fábrega E
Immunology Unit, University Hospital Marqués de Valdecilla, Santander, Spain; Instituto de Investigación Marqués de Valdecilla, Santander, Spain.
Instituto de Investigación Marqués de Valdecilla, Santander, Spain; Gastroenterology and Hepatology Unit, University Hospital Marqués de Valdecilla, Faculty of Medicine, Santander, Spain.
Transplant Proc. 2016 Nov;48(9):2980-2982. doi: 10.1016/j.transproceed.2016.08.037.
Information about the consequences of de novo donor-specific anti-human leukocyte antigen (DSA) antibody development in the long term after adult liver transplantation (LT) is scarce. We conducted a cross-sectional study in LT patients with a follow-up of at least 6 years.
A total of 28 adult LT patients were included, with a median follow-up of 77 months (range, 63 to 96) and without preformed anti- human leukocyte antigen (HLA) antibodies prior to LT. The anti-HLA identification was performed with LABScreen Single Antigen, whereas the ability to fix the complement was demonstrated with C1q test (One Lambda). In both assays, a value >3.500 mean fluorescence intensity (MFI) was considered positive. The anti-HLA antibody specificities were compared with donor HLA antigens to confirm them as DSA. Hepatic fibrosis was assessed by transient elastography.
In 5 patients (17.8%), de novo DSA were detected, all them against DQ locus. In all of these cases (100%) the complement fixation was confirmed by C1q binding. The grade of hepatic fibrosis in de novo DSA patients was significantly higher compared with No-DSA patients (13.2 ± 9.2 KPa vs 7.3 ± 3.7 KPa; P = .02). It is noteworthy that in both groups of patients the levels of liver function tests (LFT) at the time of the study were normal or near the normal range with no difference between patients with or without de novo DSA.
Our preliminary results are consistent with those previously demonstrated in pediatric LT, where de novo DSA production and humoral response could contribute to the liver fibrosis observed in the long term after LT in pediatric patients with normal or near-normal LFT.
关于成人肝移植（LT）后长期出现的新生供者特异性抗人白细胞抗原（DSA）抗体的后果的信息很少。我们对LT患者进行了一项随访至少6年的横断面研究。
共纳入28例成年LT患者，中位随访时间为77个月（范围63至96个月），LT前无预先形成的抗人白细胞抗原（HLA）抗体。使用LABScreen单抗原进行抗HLA鉴定，而通过C1q试验（One Lambda）证明补体固定能力。在这两种检测中，平均荧光强度（MFI）>3500被认为是阳性。将抗HLA抗体特异性与供者HLA抗原进行比较以确认其为DSA。通过瞬时弹性成像评估肝纤维化。
在5例患者（17.8%）中检测到新生DSA，均针对DQ位点。在所有这些病例（100%）中，通过C1q结合证实了补体固定。新生DSA患者的肝纤维化程度明显高于无DSA患者（13.2±9.2kPa对7.3±3.7kPa；P = 0.02）。值得注意的是，在两组患者中，研究时的肝功能检查（LFT）水平均正常或接近正常范围，有或无新生DSA的患者之间无差异。
我们的初步结果与先前在儿童LT中证明的结果一致，在儿童LT中，新生DSA的产生和体液反应可能导致肝功能正常或接近正常的儿童患者LT后长期观察到的肝纤维化。
