Date: Tuesday, June 4, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:18pm-3:30pm
Location: Ballroom A
*Purpose: For decades, donor-specific antibodies (DSA) have been thought not to be clinically relevant in orthotopic liver transplantation (OLT). However, recent studies have shown a negative impact of DSA class 2 (DSA2) on short term outcome of OLT recipients. So, aim of this study was to assess the long-term graft outcome with respect to the presence of DSA class 1 and 2.
*Methods: OLT recipients presenting to the outpatient clinic of the University Medical Center Hamburg Eppendorf with a 10-20 years post op follow-up were included in the study. Patients with HCV were excluded. Liver function tests, liver elastography and HLA antibodies were determined and liver histologies were reviewed. DSA with a MFI > 1500 were regarded as positive.
*Results: Altogether 132 patients with a mean follow-up of 5198 days post OLT were analysed. On last follow-up DSA2 were positive (DSA2 pos) in 55/132 (41.7 %) patients. There was no significant difference between DSA2 pos and DSA2 neg patients in terms of sex, length of follow-up post OLT, indication for OLT (Re-OLT, autoimmune, viral, alcoholic disease or other), CIT, WIT, and type of transplantation (split vs full organ). However, DSA2 pos patients were significantly younger (42y vs 59y; p < 0.001). Most importantly, the median liver stiffness on elastography of DSA2 pos patients was significantly higher than of DSA2 neg patients (9.4 ± 9.7 vs 6.9 ± 7.1 kPa; p < 0.001). In agreement, on liver histology (n=53) more DSA2 pos patients were found to have fibrosis > stage I (69.7% vs 40%, p = 0.03). Also a significant higher incidence of chronic rejections (12.7% vs 2.6%; p=0.02) and graft losses (5.5% vs 0%; p=0.04) were found in DSA2 pos as compared to DSA2 neg patients. However, there was no significant difference between DSA2 pos and DSA2 neg patients with regard to early or late acute rejection episodes.
DSA class 1 (DSA1) were only positive in 22/137 (15.3%) of patients on last follow-up. However, there was difference between DSA 1 positive and negative patients in terms of any patient characteristics or graft outcome.
*Conclusions: Presence of DSA class 2 was associated with increased fibrosis grade, higher incidence of chronic rejection and graft loss in long-term liver transplant recipients.
To cite this abstract in AMA style:Sterneck M, Sultani B, Lago MRodriguez, Grabhorn E, Briem-Richter A, Herden U, Fischer L. Presence of DSA Class 2 is Associated with Fibrosis Progression after OLT [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/presence-of-dsa-class-2-is-associated-with-fibrosis-progression-after-olt/. Accessed March 2, 2021.
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