Donor Specific Antibody and Long-Term Outcome After Liver Transplantation: A Systematic Review and Meta-Analysis.

BACKGROUND

The impact of anti-HLA donor-specific alloantibodies (DSA) which develop after long-term liver transplantation (LT) remains controversial and unclear. The aim of this study was to investigate the role of DSAs on the outcome in LT.

METHODS

We did a systematic review and meta-analysis of observational studies published until Dec 31, 2019, that reported DSA outcome data (≥1 year of follow-up) after liver transplant. A literature search in the MEDLINE/PubMed, EMBASE, Cochrane Library, Scopus and Web of Science Core Collection databases was performed.

RESULTS

Of 5,325 studies identified, 15 fulfilled our inclusion criteria. The studies which reported 2016 liver transplant recipients with DSAs showed an increased complication risk, i.e. graft loss and chronic rejection (OR 3.61; 95% CI 1.94-6.71, < 0.001; I 58.19%), and allograft rejection alone (OR 6.43; 95% CI: 3.17-13.04; < 0.001; I 49.77%); they were compared to patients without DSAs. The association between DSAs and overall outcome failure was consistent across all subgroups and sensitivity analysis.

CONCLUSIONS

Our study suggested that DSAs had a significant deleterious impact on the liver transplant risk of rejection. The routine detection of DSAs may be beneficial as noninvasive biomarker-guided risk stratification.