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.
Langenbecks Arch Surg. 2019 Nov;404(7):865-874. doi: 10.1007/s00423-019-01831-9. Epub 2019 Nov 20.
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.
Data of consecutive patients undergoing orthotopic LT (OLT) at the South Australian Liver Transplant Unit was analysed. All patients underwent DSA testing pre-transplant.
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.
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.
肝移植（LT）候选者的数量与合适的肝供体之间存在越来越大的差距。抗体介导的排斥反应（AMR）继发于阳性供体特异性抗体（DSA），仍然是肝移植中的一个关注点。本研究旨在探讨移植前筛查时 DSA 的表达与 LT 结果之间的关系，特别是肝移植后 AMR 的发展和肝功能谱。
分析了在南澳大利亚肝移植单位接受原位肝移植（OLT）的连续患者的数据。所有患者在移植前均进行了 DSA 检测。
在 96 例患者队列中，OLT 后中位随访 849 天，仅 2 例（2%）患者发生 AMR。虽然这两名患者术前均有阳性 DSA 检测结果，但 31%的患者存在 DSA 阳性，其预测 AMR 的特异性为 0.708。AMR（p=0.092）、T 细胞介导的排斥反应/TCMR（p=0.797）或晚期肝动脉血栓形成/LHAT（p=0.521）之间均无显著相关性。在 100 天的时间内，DSA 阳性与血清胆红素或转氨酶之间没有显著的交互作用。
LT 后 AMR 并不常见。移植前的 DSA 阳性并不意味着 AMR 的明确风险。此外，在时间上，DSA 表达与血清胆红素或转氨酶水平之间不存在显著的相互作用。在全球 LT 供体短缺的情况下，在边缘供体的广泛背景下，考虑 DSA 阳性供体似乎是合理的，除非出现相反的证据。
