Immunologic Benefits of Maternal Living Donor Allografts in Pediatric Liver Transplantation: Less Rejection Episodes and No Evidence of De Novo Allosensitization

A. Barbetta¹, G. Meeberg², B. Rocque¹, S. Barhouma³, S. Gilmour⁴, F. Faytrouni⁵, O. Guttman⁵, P. Campbell⁴, J. Shapiro², J. Emamaullee¹

¹Surgery, Abdominal Transplant, University of Southern California, Los Angeles, CA, ²Surgery, University of Alberta, Edmonton, AB, Canada, ³University of Southern California, Los Angeles, CA, ⁴University of Alberta, Edmonton, AB, Canada, ⁵University of British Columbia, Vancouver, BC, Canada

Meeting: 2021 American Transplant Congress

Abstract number: 1163

Keywords: Donors, unrelated, Infant, Microchimerism, Tolerance

Topic: Clinical Science » Liver » Liver: Pediatrics

Session Information

Session Name: Liver: Pediatrics

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Living donor liver transplantation (LDLT) offers improved graft and patient survival in pediatric liver transplant (LT) recipients. Prior studies have suggested immunological advantage when using maternal living liver donors (LLDs), with less rejection episodes. It is unclear if this benefit extends to reduce risk of developing donor-specific antibody (DSA) and crossmatch positivity among maternal donors and child recipient pairs. The aim of this study was to evaluate immunologic outcomes following pediatric LT, comparing maternal LLD grafts to non-maternal LLD and deceased donor (DD) grafts.

*Methods: Children (<18 years) who underwent LT between January 2005-December 2017 at a single, high volume center where retrospective crossmatch is routinely performed were evaluated. Patients were divided in 3 groups according to type of graft received (maternal LLD, non-maternal LLD, and DD). Clinical variables and outcomes were compared using the Fisher exact test for categorical variables and Kruskal-Wallis test for continuous variables. Patient and graft survival were analyzed using the Kaplan-Meier method.

*Results: A total of 110 pediatric LT recipients met inclusion criteria. In the study period, 58 (52.7%) children received a DD graft, 34 (10.9%) received non-maternal LLD and 18 (16.4%) received a maternal LLD graft. There were no differences in demographics, PELD, medical status at transplant, ABO compatibility, or crossmatch positivity among the three groups. Children receiving living liver donor graft were less likely to develop rejection when compared to the DD group (DD 71.2% vs Maternal LLD 46.7% vs non-maternal LLD32.4%, p=0.001). Among patients were tested for pre-transplant DSA, 6 DD recipients, 2 maternal and 2 non-maternal LLD recipients had pre-formed DSA. Post-transplant, de novo DSA were identified in 5 DD and 3 non-maternal LLD recipients. No recipients of maternal LLD grafts developed de novo DSA. Only 4 patients had both pre-formed and de-novo DSA, but none of the patients with positive DSA developed antibody mediated rejection. There were no differences in overall patient and graft survival among the three cohorts.

*Conclusions: These data support the concept of immunologic benefit of maternal LLD in pediatric LT, with lower rates of rejection and no evidence of allosensitization post-LT. Recipients of maternal LLD grafts be examined as potential candidates for immunosuppression minimization and withdrawal protocols

To cite this abstract in AMA style:

Barbetta A, Meeberg G, Rocque B, Barhouma S, Gilmour S, Faytrouni F, Guttman O, Campbell P, Shapiro J, Emamaullee J. Immunologic Benefits of Maternal Living Donor Allografts in Pediatric Liver Transplantation: Less Rejection Episodes and No Evidence of De Novo Allosensitization [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/immunologic-benefits-of-maternal-living-donor-allografts-in-pediatric-liver-transplantation-less-rejection-episodes-and-no-evidence-of-de-novo-allosensitization/. Accessed May 31, 2025.

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