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The Impact of Rapamycin Conversion in Pediatric Liver Transplantation on Anti-HLA Antibody Formation and Allograft Fibrosis

R. Fischer,2 L. Fromm,1 J. Daniel,2 A. Kats,2 R. Hendrickson,2 W. Andrews.2

1University of Kansas College of Medicine, Kansas City, KS
2Children's Mercy Hospital, Kansas City, MO.

Meeting: 2018 American Transplant Congress

Abstract number: B281

Keywords: HLA antibodies, Immunosuppression, Liver

Session Information

Session Name: Poster Session B: Liver: Pediatrics

Session Type: Poster Session

Date: Sunday, June 3, 2018

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Background: Maintenance immunosuppression with tacrolimus (TAC) is associated with progressive liver allograft fibrosis. Conversion to rapamycin (RAPA) may abrogate this progression. The development of donor-specific anti-human leukocyte antigen antibodies (anti-HLA) may contribute to organ rejection and fibrosis. We compared the impact of conversion from TAC to RAPA on the anti-HLA profile and allograft fibrosis in children.

Methods: We retrospectively analyzed the records of 34 patients transplanted between 1994 and 2013. We noted the development and persistence of anti-HLA in patients on maintenance TAC (n= 16) compared to those converted to RAPA (n=18). Patients were categorized by the maintenance immunosuppression at the time of most recent biopsy. We noted anti-HLA at the time of first surveillance biopsy on TAC (~12 months post-transplant), most recent biopsy on TAC and most recent biopsy on RAPA (if applicable). Liver fibrosis was assessed using the METAVIR scoring system. Anti-HLA were considered positive if the mean fluorescence intensity > 1000.

Results: Only one patient in each group was positive for class I anti-HLA on most recent biopsy. Of the 18 patients converted to RAPA, 2 of 11 patients that were class II anti-HLA on TAC became anti-HLA negative on RAPA. Of the 16 patients maintained on TAC, 9 were class II anti-HLA positive on their first surveillance biopsy, and 11 were positive on their most recent biopsy on TAC (see figure). One RAPA patient lost DQ anti-HLA, and another lost the DQ, DR, and DP serotypes. One TAC patient lost DQ anti-HLA, while two acquired DQ, DR and DP serotypes and one acquired DR anti-HLA. Patients on RAPA showed reduced fibrosis in 39% of patients, including the two patients that lost anti-HLA.

Conclusion: These data suggest RAPA maintenance therapy may inhibit anti-HLA development in pediatric liver transplant patients and may contribute to decreased allograft fibrosis. Further evaluation of larger patient populations is indicated.

CITATION INFORMATION: Fischer R., Fromm L., Daniel J., Kats A., Hendrickson R., Andrews W. The Impact of Rapamycin Conversion in Pediatric Liver Transplantation on Anti-HLA Antibody Formation and Allograft Fibrosis Am J Transplant. 2017;17 (suppl 3).

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To cite this abstract in AMA style:

Fischer R, Fromm L, Daniel J, Kats A, Hendrickson R, Andrews W. The Impact of Rapamycin Conversion in Pediatric Liver Transplantation on Anti-HLA Antibody Formation and Allograft Fibrosis [abstract]. https://atcmeetingabstracts.com/abstract/the-impact-of-rapamycin-conversion-in-pediatric-liver-transplantation-on-anti-hla-antibody-formation-and-allograft-fibrosis/. Accessed May 9, 2025.

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