PMID- 30229989
OWN - NLM
STAT- MEDLINE
DCOM- 20200528
LR  - 20211204
IS  - 1527-3350 (Electronic)
IS  - 0270-9139 (Linking)
VI  - 69
IP  - 3
DP  - 2019 Mar
TI  - Prevalence and Impact of De Novo Donor-Specific Antibodies During a Multicenter 
      Immunosuppression Withdrawal Trial in Adult Liver Transplant Recipients.
PG  - 1273-1286
LID - 10.1002/hep.30281 [doi]
AB  - The development of human leukocyte antigen (HLA) donor-specific 
      antibody/antibodies (DSA) is not well described in liver transplant (LT) patients 
      undergoing immunosuppression (IS) withdrawal protocols despite the allograft risk 
      associated with de novo DSA (dnDSA). We analyzed the development of dnDSA in 69 
      LT patients who received calcineurin inhibitor monotherapy and were enrolled in 
      the ITN030ST study. Of these 69 patients, 40 stable patients were randomized to 
      IS maintenance (n = 9) or IS minimization (n = 31). Nine of the 31 IS 
      minimization patients achieved complete withdrawal and were free of IS. Among 
      patients who achieved stable IS monotherapy 1 year after transplantation, the 
      prevalence of dnDSA was 18.8%. Acute rejections and the biopsy-proven findings 
      disqualifying patients from IS withdrawal attempt were factors associated with 
      dnDSA development (P = 0.011 and P = 0.041, respectively). Among randomized 
      patients, dnDSA prevalence was 51.7% after IS minimization and 66.7% in IS-free 
      patients. dnDSA prevalence in patients on IS maintenance was 44.4%. dnDSA 
      development during IS minimization was a risk factor for acute rejection (P = 
      0.015). The majority of dnDSA were against HLA-DQ antigens (78.7%). Conclusion. 
      During the first year following transplantation, acute rejections increase the 
      risk of developing dnDSA, so dnDSA positivity should be considered for IS 
      withdrawal eligibility; during IS minimization, dnDSA development was associated 
      with acute rejection, which prevented further IS withdrawal attempts.
CI  - (c) 2018 by the American Association for the Study of Liver Diseases.
FAU - Jucaud, Vadim
AU  - Jucaud V
AUID- ORCID: 0000-0003-0385-2623
AD  - Terasaki Research Institute, Los Angeles, CA.
FAU - Shaked, Abraham
AU  - Shaked A
AD  - University of Pennsylvania, Philadelphia, PA.
FAU - DesMarais, Michele
AU  - DesMarais M
AUID- ORCID: 0000-0002-0063-907X
AD  - Immune Tolerance Network, San Francisco, CA.
FAU - Sayre, Peter
AU  - Sayre P
AD  - Immune Tolerance Network, San Francisco, CA.
AD  - University of California San Francisco, San Francisco, CA.
FAU - Feng, Sandy
AU  - Feng S
AD  - University of California San Francisco, San Francisco, CA.
FAU - Levitsky, Josh
AU  - Levitsky J
AD  - Northwestern University, Chicago, IL.
FAU - Everly, Matthew J
AU  - Everly MJ
AD  - Terasaki Research Institute, Los Angeles, CA.
LA  - eng
GR  - Terasaki Research Institute/International
GR  - UM1 AI109565/AI/NIAID NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20190208
PL  - United States
TA  - Hepatology
JT  - Hepatology (Baltimore, Md.)
JID - 8302946
RN  - 0 (HLA Antigens)
SB  - IM
CIN - Hepatology. 2019 May;69(5):2302-2303. PMID: 30394549
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - *Antibody Formation
MH  - Child
MH  - Female
MH  - HLA Antigens/*biosynthesis
MH  - Humans
MH  - *Immunosuppression Therapy
MH  - *Liver Transplantation
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Tissue Donors
MH  - *Transplantation Immunology
MH  - *Withholding Treatment
MH  - Young Adult
EDAT- 2018/09/20 06:00
MHDA- 2020/05/29 06:00
CRDT- 2018/09/20 06:00
PHST- 2018/05/21 00:00 [received]
PHST- 2018/09/09 00:00 [accepted]
PHST- 2018/09/20 06:00 [pubmed]
PHST- 2020/05/29 06:00 [medline]
PHST- 2018/09/20 06:00 [entrez]
AID - 10.1002/hep.30281 [doi]
PST - ppublish
SO  - Hepatology. 2019 Mar;69(3):1273-1286. doi: 10.1002/hep.30281. Epub 2019 Feb 8.