Mothers Are Often Sensitized and Sensitive: Antibody Mediated Rejection in Child to Mother Living Donor Liver Transplantation.
1Division of Organ Transplantation, UMass Memorial Medical Center, Worcester, MA
2Clinical Pathology, Histocompatibility Laboratory, UMass Memorial Medical Center, Worcester, MA.
Meeting: 2016 American Transplant Congress
Abstract number: 139
Keywords: HLA antibodies, Liver transplantation, Living-related liver donors, Rejection
Session Information
Session Name: Concurrent Session: Liver: Immunosuppression and Rejection
Session Type: Concurrent Session
Date: Sunday, June 12, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 312
Background: Partial graft is especially more vulnerable to deleterious effects of donor specific HLA antibodies (DSA). Living liver donors and recipients are often family members. Mothers are at risk of immunological sensitization to their children at time of birth.
Aim: To assess presence of donor specific HLA antibodies and the risk of antibody mediated rejection in female patients receiving a living donor liver graft from one of their children.
Methods: Retrospective analysis of all living donor liver transplant (LDLT) recipients in a single academic center between 2011 -2015 was performed. Patients were divided in two subgroups: 1) Mothers receiving a living donor liver graft from one of their children and 2) all other LDLT recipients. Pre-transplant HLA antibody profile, complement-dependent cytotoxicity (CDC) and anti-human globulin-CDC cross match, incidence of post transplant antibody mediated rejection (AMR) as well as transplant outcome were compared between the two groups.
Results: A total of 21 consecutive LDLT cases were performed. Eight women received LDLT from either a son or daughter. Four out of eight mothers (50%) had one or more preexisting DSAs, versus 2 out 13 in the other group (15%). CDC and AHG-CDC cross matches were negative in all patients except in one mother receiving a liver lobe from her daughter, whose CDC B cell cross match was positive. Three out of 8 mothers (38%) were diagnosed with clinically significant and biopsy proven antibody mediated rejection (C4D positive), as opposed to none of the other patients (P=0.04). All antibody mediated rejections occurred within the first 2 weeks after transplant. Patient with AMR required longer hospital stay, AMR-directed treatment and frequent monitoring. With appropriate therapy, one-year graft survival was 100%.
Conclusion: Mothers receiving a LDLT from one of their children are at significant higher risk of AMR than the general population. A negative CDC cross match does not rule out early post transplant AMR. Patients with pre-existing DSA are at high risk of developing AMR post transplant and maybe a candidate for pre-transplant desensitization.
CITATION INFORMATION: Movahedi B, Yu N, Martins P, Ahearn A, Stoff J, Bozorgzadeh A. Mothers Are Often Sensitized and Sensitive: Antibody Mediated Rejection in Child to Mother Living Donor Liver Transplantation. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Movahedi B, Yu N, Martins P, Ahearn A, Stoff J, Bozorgzadeh A. Mothers Are Often Sensitized and Sensitive: Antibody Mediated Rejection in Child to Mother Living Donor Liver Transplantation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/mothers-are-often-sensitized-and-sensitive-antibody-mediated-rejection-in-child-to-mother-living-donor-liver-transplantation/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress