Purpose: Although alloantibodies, and donor-specific antibodies (DSA) in particular, are well-known to negatively impact graft survival in human solid organ transplantation, little is known about their relevance in vascularized composite allotransplantation (VCA). The purpose of this study was to analyze the occurrence and clinical significance of alloantibodies in hand transplanted patients.

Methods: All hand transplant centers known in the public domain, as of July 12 2016, were invited to participate. A total of 15 centers joined the study, comprising 44 patients with available antibody data. 43 patients met inclusion criteria and were assessed for demographics, antibody type (DSA, non-DSA, non-HLA). Functional assessment was available in 35 patients (Hand Transplant Scoring System (HTSS) and Disability of Arm Shoulder and Hand (DASH)). Rejections, antibody status and functional outcomes were analyzed with Kaplan Meier comparisons.

Results: DSA correlated significantly with grade I and II rejections (Figure 1A-C). DSA subtype was not a determinant factor. Functional outcome, as measured by HTSS and DASH scores, showed no relationship with antibody development in neither unilateral nor bilateral hand transplants. Conclusions: This is the first multicenter study showing a correlation between DSA development and acute rejection among hand transplant recipients. This highlights the need for a structured follow-up of VCA patients experiencing antibody-mediated rejection (AMR) and DSA development. Establishment of strategies for the treatment of AMR, and implementation of AMR in the current cell-mediated based VCA Banff classification system is called for.

CITATION INFORMATION: Berglund E, Andersen Ljungdahl M, Bogdanovic D, Berglund D, Wadström J, Weissenbacher A, Petruzzo P, Schneeberger S. Clinical Significance of Alloantibodies in Hand Transplantation: Impact on Rejection and Functional Outcome. Am J Transplant. 2017;17 (suppl 3).

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