Effect of HLA Antibodies on Graft Survival in Adult Live Donor Liver Transplantation
1Transplantation, Lahey Hospital & Medical Center, Burlington, MA
2Transplantation, University of Colorado Medical Center, Aurora, CO.
Meeting: 2018 American Transplant Congress
Abstract number: 555
Keywords: HLA antibodies, IVIG, Liver transplantation
Session Information
Session Name: Concurrent Session: Liver: Living Donors and Partial Grafts
Session Type: Concurrent Session
Date: Tuesday, June 5, 2018
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: Room 608/609
The relevance of HLA antibodies in liver transplantation is currently being re-evaluated. While hyperacute rejections are not an issue, antibody effects on long-term outcomes are not well characterized. In this study, we evaluated the impact of HLA antibodies and positive crossmatches (XM) in a cohort of adult live donor liver transplant (LDLT) recipients.
Methods: All LDLT recipients transplanted between 8/2002 and 10/2017 were included. HLA antibody screens and donor-recipient cytotoxic XMs were performed on all recipients. Positive XMs were diluted; patients with titers >1:8 were treated with plasmapheresis (PP) and intravenous immunoglobulin (IVIg); those with lower titers received IVIg alone. XMs were repeated after treatment and if still positive, PP and IVIg were repeated.
Results: A total of 232 LDLT recipients were evaluated. Males predominated (m=161, f=71) and mean age at transplant = 52.1 (range 19-73 years). 51 patients had positive XMs and/or HLA antibodies (30 F-58.8% v. 21 M, 41.2%, p=0.021). 42.2% of total female cohort demonstrated antibodies versus 13.1% of males (p<0.001). Graft survival was significantly lower in patients with HLA antibodies at 1 and 3 years (Table 1).
| Year | Abs | NoAbs | p |
| 1 | 81.9 | 94.3 | .038 |
| 3 | 78.9 | 87.5 | .05 |
| 5 | 74.2 | 82.6 | NS |
| 10 | 58.3 | 71.7 | NS |
Patients with donor specific antibodies (DSA) but negative XM (n=4) had no graft losses; with positive DSA+XM (n=13) 1,3, and 5 year survival = 92.3, 90.1, 83.3%; with antibodies but no DSAs (n=33) 1,3, and 5 year survival = 78.2, 70.3, 68.5% (p=0.001) (Figure 1)
In conclusion, preformed HLA antibodies present at time of LDLT are associated with inferior graft survival compared to patients transplanted without antibodies. Following treatment of DSAs with IVIg + PP, graft survival is equivalent to patients without antibodies. Additional study is required to delineate mechanism of these findings.
CITATION INFORMATION: Simpson M., Akoad M., Gordon F., Cheah Y-.L., Simon C., Pomposelli J., Pomfret E. Effect of HLA Antibodies on Graft Survival in Adult Live Donor Liver Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Simpson M, Akoad M, Gordon F, Cheah Y-L, Simon C, Pomposelli J, Pomfret E. Effect of HLA Antibodies on Graft Survival in Adult Live Donor Liver Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/effect-of-hla-antibodies-on-graft-survival-in-adult-live-donor-liver-transplantation/. Accessed November 23, 2024.« Back to 2018 American Transplant Congress