Liver Transplant Recipients with High DSA at Time of Transplant Do Not Have Increased Rejection or Mortality

A. Demirag¹, B. Rawashdeh¹, S. L. Lennon¹, S. Pelletier¹, J. Iezzoni², K. Khutsisvhili³, S. Shumilina¹, K. Chittum¹, J. Oberholzer¹, P. Lobo⁴

¹Department of Surgery, University of Virginia Medical Cener, Charlottesville, VA, ²Department of Pathology, University of Virginia Medical Cener, Charlottesville, VA, ³Histocompatibility Laboratory, University of Virginia Medical Cener, Charlottesville, VA, ⁴Department of Medicine, University of Virginia Medical Cener, Charlottesville, VA

Meeting: 2020 American Transplant Congress

Abstract number: 154

Keywords: HLA antibodies, Liver grafts, Rejection

Session Information

Session Name: Liver: Immunosuppression and Rejection

Session Type: Oral Abstract Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:45pm

Presentation Time: 3:51pm-4:03pm

Location: Virtual

*Purpose: Currently, there is controversy regarding transplanting livers in setting of high HLA-class ll DSA especially since prior studies demonstrated enhanced acute rejections in this setting (JG.O’Leary et.al Liver Transplantation 2013). We therefore did a retrospective study of all liver transplants performed at our institution, between January 2014 to May 1^st 2019, to determine if high DSA levels, at time of transplant enhances rejection rates and patient mortality.

*Methods: Methods: Class l and ll DSA at the time of transplant were phenotyped and quantitated using single antigen beads (Luminex, One lambda). DSA were also identified with a pronase flow cross match (FCXM). Only biopsy confirmed rejections, occurring in the first 6 months post-transplant are included in this analysis. The patients were treated with triple immunosuppressive regimens that included CNI inhibitors, prednisone and mycophenolate.

*Results: Results: The data of 361 liver transplants performed during this period are summarized in attached table. The data would indicate that high DSA levels at time of transplant do not enhance biopsy proven acute rejections occurring in the first 6 months post-transplant. Only one patient with rejection in setting of DSA (ClassII, MFI more than 20,000) required plasmapheresis and IVIG. In patients where simultaneous FCXM was performed, only two of 24 patients with high DSA and positive FCXM had rejection episodes. No liver allografts were lost in first 6 months from acute rejection.

*Conclusions: In conclusion, in this single center retrospective study, DSA at time transplant, had no detrimental effect on outcome of liver transplants.


DSA Level (MFI)	Number of Patients	Number of Patients with rejections (less than 6 months post-Tx)	Number of Deaths (during study period)
None	329	36 (10.9%)	16 (4.8%)
Class I
5000-10000	5	0	2 (40.0%)
More than 10000	12	1 (8.3%)	0
Class II
5000-10000	12	1 (8.3%)	0
More than 10000	20	1 (5.0%)	1 (5.0%)

To cite this abstract in AMA style:

Demirag A, Rawashdeh B, Lennon SL, Pelletier S, Iezzoni J, Khutsisvhili K, Shumilina S, Chittum K, Oberholzer J, Lobo P. Liver Transplant Recipients with High DSA at Time of Transplant Do Not Have Increased Rejection or Mortality [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/liver-transplant-recipients-with-high-dsa-at-time-of-transplant-do-not-have-increased-rejection-or-mortality/. Accessed May 16, 2025.

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