Aim: To evaluate the impact of preformed donor specific alloantibodies (DSA) on the risk of rejection and patient survival after isolated liver transplantation (LT). Methods: Since 1985, our biorepository prospectively collects protocol serum samples from all donors and recipients of LT in conjunction with a clinical and laboratory research database. We analyzed all 1270 adult recipients of a primary LT without another organ from 1/00 to 5/09 with a pre-LT sample available for analysis of DSA (95.8% of patients). 87.3% also had a post-LT sample tested for DSA. All patients had their serum blinded and analyzed with LABScreenTM single antigen beads. Results: 65.4% of LT recipients were male, 72.7% Caucasian with a calculated MELD of 16 and a median recipient and donor age of 52 and 42 respectively. Patients indication for transplant was HCV 31.3%, HCC 24.1%, autoimmune conditions 13.9%, and alcohol 11.2%. 42.4% of patients received induction therapy, and 3-month immunosuppression included tacrolimus 64.6%, steroids 54.3%, mycophenolate 51%, and sirolimus 15.4% of the time. 14.5% of patients had preformed class I &/or II DSA with a Mean Florescence Intensity (MFI) >5000. Preformed class I DSA with a MFI >5000 only remained persistent 5% of the time and did not increase the risk for rejection. Preformed class II DSA with a MFI from 5000-10,000 remained persistent 23% of the time, which increased to 33% of the time in patients whose preformed MFI was >10,000 (p<0.001). Preformed class II dramatically increased the risk of early rejection, a risk that was completely abated with induction therapy. In addition, multivariable modeling showed preformed class I &/or II DSA with a MFI >5000 [compared to patients without DSA (MFI <1000)] was an independent predictor of patient death that was unchanged by induction.
Terasaki, P.: Stockholder, One Lambda, Chairman.
To cite this abstract in AMA style:O'Leary J, Kaneku H, Jennings L, Susskind B, Terasaki P, Klintmalm G. High MFI Preformed Class II HLA Donor Specific Alloantibodies Increase the Risk of Early Rejection and Death after Liver-Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). http://atcmeetingabstracts.com/abstract/high-mfi-preformed-class-ii-hla-donor-specific-alloantibodies-increase-the-risk-of-early-rejection-and-death-after-liver-transplantation/. Accessed November 19, 2017.
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