PMID- 31245404
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220409
IS  - 2304-3881 (Print)
IS  - 2304-389X (Electronic)
IS  - 2304-3881 (Linking)
VI  - 8
IP  - 3
DP  - 2019 Jun
TI  - The impact of alloantibodies directed against the second donor on long-term 
      outcomes of repeat liver transplantation.
PG  - 246-252
LID - 10.21037/hbsn.2019.01.14 [doi]
AB  - BACKGROUND: Despite reports that associate donor specific antibody (DSA) with 
      rejection after liver transplantation, grafts are still allocated according to 
      blood group (ABO) but not human leukocyte antigen (HLA) compatibility, possibly 
      due to the absence of an easily discernible clinical association between adverse 
      recipient outcome and DSA. Re-transplantation provides a test environment where 
      the presence of preformed DSA is prevalent and its effect on outcome should be 
      apparent. METHODS: All patients undergoing a second liver transplantation with 
      available pre-operative serum were included with the exception of ABO 
      incompatible or multiple organ transplants. Banked sera were tested for anti-HLA 
      antibodies with Luminex-based solid phase assays. Anti-HLA antibodies to the 
      second donor (D2SA) were determined using antibodies specificity and HLA typing 
      of 2nd liver donor. RESULTS: Preformed HLA antibodies directed to second liver 
      transplantation (D2SA) were found in 31 (39%) of the 79 patients that were 
      included in the study. Primary and re-transplantation characteristics were 
      similar in both subgroups except first graft survival which was significantly 
      shorter in recipients who are negative for D2SA. Mean survival of the second 
      graft was similar in D2SA+ and D2SA- cohorts [8.55 (range, 0.01-24.74) vs. 7.56 
      (range, 0-23.53) years respectively, P=0.574]. Mean patient survival after 2nd 
      liver transplantation was similar in D2SA+ and D2SA- cohorts [9.11 (range, 
      0.01-24.74) vs. 8.10 (range, 0-23.53) years respectively, P=0.504]. Subgroup 
      univariate analysis demonstrated no detrimental effect of class, locus, or 
      strength of D2SA on survival of the second liver transplant. In multivariate cox 
      regression model, neither class I D2DSA (HR =1.101, P=0.92) nor class II D2SA (HR 
      =1.74, P=0.359) were significant risks of graft failure. CONCLUSIONS: Presence of 
      D2SA was not found to be associated with inferior outcomes in this retrospective 
      cohort study of liver re-transplantation suggesting that changes to the 
      allocation system are not required.
FAU - Xu, Qingyong
AU  - Xu Q
AD  - Department of Pathology and Lab Medicine, University of Western Ontario, London, 
      ON, Canada.
FAU - Shrum, Brad
AU  - Shrum B
AD  - Department of Surgery, University of Western Ontario, London, ON, Canada.
FAU - Leckie, Steve
AU  - Leckie S
AD  - Department of Pathology and Lab Medicine, University of Western Ontario, London, 
      ON, Canada.
FAU - Skaro, Anton
AU  - Skaro A
AD  - Department of Surgery, University of Western Ontario, London, ON, Canada.
FAU - McAlister, Vivian C
AU  - McAlister VC
AD  - Department of Surgery, University of Western Ontario, London, ON, Canada.
LA  - eng
PT  - Journal Article
PL  - China (Republic : 1949- )
TA  - Hepatobiliary Surg Nutr
JT  - Hepatobiliary surgery and nutrition
JID - 101600750
PMC - PMC6561887
OTO - NOTNLM
OT  - Donor-specific antibodies (DSA)
OT  - human leucocytes antigen (HLA)
OT  - liver transplantation
COIS- Conflicts of Interest: Presented at American Transplant Congress 2018, Seattle, 
      WA, USA. Data sharing: Anonymized subject level data will be available. 
      Registered with www.clinicaltrials.gov NCT03815864.
EDAT- 2019/06/28 06:00
MHDA- 2019/06/28 06:01
PMCR- 2019/06/01
CRDT- 2019/06/28 06:00
PHST- 2019/06/28 06:00 [entrez]
PHST- 2019/06/28 06:00 [pubmed]
PHST- 2019/06/28 06:01 [medline]
PHST- 2019/06/01 00:00 [pmc-release]
AID - hbsn-08-03-246 [pii]
AID - 10.21037/hbsn.2019.01.14 [doi]
PST - ppublish
SO  - Hepatobiliary Surg Nutr. 2019 Jun;8(3):246-252. doi: 10.21037/hbsn.2019.01.14.