Date: Saturday, May 2, 2015
Session Name: Poster Session A: Liver: Immunosuppression and Rejection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
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.
To cite this abstract in AMA style:Bello ADel, Congy-Jolivet N, Milongo D, Guilbeau-Frugier C, Lavayssière L, Muscari F, Rostaing L, Kamar N. Incidence and Impact of De Novo Donor-Specific Anti-HLA Antibodies in ABO-Compatible Liver-Transplant Recipients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-and-impact-of-de-novo-donor-specific-anti-hla-antibodies-in-abo-compatible-liver-transplant-recipients/. Accessed November 21, 2019.
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