Background: The incidence and consequences of de novo donor-specific anti-HLA antibodies (DSAs) after liver transplantation (LT) are not well known. Thus, we investigated the incidence, kinetic occurrence, and complications associated with de novo DSAs.

Patients and Methods: All patients, without preformed anti-HLA DSAs, that received a liver transplant between February 2008 and Sept 2013 in our center were tested for anti-HLA antibodies, with the Luminex SA™ assay, at day 0, month (M)1, M3, M6, M9, at 1 year, and then annually until last follow-up.

Results: Of the 152 patients included, at the last follow-up (34 [1.5-77]) months post-transplantation, 21 patients (14%) had developed de novo DSAs. Thirteen patients had developed anti-HLA DSAs before one year, including 7 patients in the first 6 months post-transplantation. Patients with low exposure to calcineurin-inhibitors and noncompliant patients had an increased likelihood of de novo DSA formation. However, older recipients at transplantation had a significantly lower likelihood of de novo DSA occurrence. 9/21 patients with de novo DSAs had a rejection that met the criterion of acute antibody-mediated rejection: C4d positivity in the liver biopsy was more frequent in antibody-mediated rejection group (9/9 vs. 1/12, p=0.0001). All patients received steroid pulses; plus eight patients received a B-cell targeting therapy (rituximab: n=8; plasma exchange: n=6; intravenous immunoglobulins: n=6) and one patient received polyclonal antibodies. Evolution was favorable for seven patients. During the follow-up, 27 (17%) patients died (1/21 patients with de novo DSAs and 26/131 patients without DSAs).

Conclusion: the incidence of de novo DSAs was 14%. Incidence of antibody-mediated rejection was 6%. There were no differences concerning graft- and patient-survival rates according to de novo DSA status and after appropriate treatment for antibody-mediated rejection.

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