Donor specific antibodies (DSA) are known to play a pivotal role in long term kidney allograft survival. Their importance in liver transplanted patients (LTX) is still controversial. To analyze the impact of pre-existing DSA on acute rejection and graft survival in first adult liver transplant (LTX) patients we retrospectively screened sera of 173 patients transplanted between 1.5.2008 and 30.9.2014 for HLA Abs by Luminex single antigen bead assays.

The mean follow up (FU) of the patients was 38 months.

In 123/173 patients (71%) HLA Abs were detectable before LTX. In 56/173 (32%) the Abs were identified to be donor specific in retrospect. In 20 sera donor specificity could not be determined due to missing of complete donor HLA-typing.

We compared patients with DSA (n=50) and patients without any HLA Abs (n=56). Patients with non donor specific Abs and undefined Abs were excluded (n=67).

Patients with and without DSA did not significantly differ in age, BMI, labMELD pre LTX or primary liver disease.

During FU 4 graft losses and 8 death occurred in patients without HLA Abs and 6 graft losses and 8 death in patients with DSA. Reasons for graft loss were primary non function (n=6), HCV recurrence (n=1), multi organ failure (n=1), bile duct necrosis (n=1) and chronic rejection (n=1with DSA). There was no difference in graft or patient survival between patients with and without pre-existing Abs.

Early bile duct complications were higher in the DSA group (20% vs. 10%) and acute rejections are diagnosed more often with DSA (35% vs. 24%). The difference did not reach statistical significance.

Bilirubin and gGT in sera were not different between the groups 1, 2, and 3 years post transplantation.

We conclude that HLA Abs and DSA are frequent in first adualt liver transplant patients. During the FU of three years only one graft loss due to chronic rejection occurred (<1%). There was no difference in patient or graft survival between patients with preformed DSA or no Abs. Liver function was not different between the groups 1, 2, and 3 years post transplantation.

Pre transplant HLA Abs analysis or HLA matching seems not to be useful in first adult liver transplant patients.

This study was supported by Novartis Pharma.

CITATION INFORMATION: Koch M, Marget M, Sterneck M, Thude H, Nashan B. Limited Impact of Pre-Existing Donor Specific HLA Antibodies on Long Term Survival After First Adult Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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