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 LABScreen^TM 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. Patient’s 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.

« Back to 2013 American Transplant Congress