Liver graft injury caused by de novo donor-specific HLA antibodies in pediatric liver transplant recipients with low, moderate, and high immunologic risk

• Published in: The American journal of surgery Vol. 225; no. 2; pp. 275 - 281
• Main Authors: Liu, Wei, Wang, Zheng-Lu, Kang, Zhong-Yu, Xiao, Yan-Li, Liu, Chun, Li, Dai-Hong
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2023; Elsevier Limited
• Subjects: Antibodies; Antigens; Bilirubin; Biopsy; Child; De novo donor-specific anti-HLA antibodies; Fibrosis; Fluorescence; Graft rejection; Graft Rejection - etiology; Graft Survival; Grafting; Health risks; Histocompatibility antigen HLA; Humans; Injuries; Kidney Transplantation; Leukocytes; Liver; Liver Cirrhosis; Liver graft injury; Liver Transplantation; Liver transplants; Lymphocytes; Lymphocytes T; Patients; Pediatric liver transplantation; Pediatrics; Rejection; Retrospective Studies; Risk Factors; Risk groups; Risk levels; Software; Statistical analysis; Survival; Tissue Donors; Transplant Recipients; Transplantation; United States > US; Rejection; Pediatric liver transplantation; Fibrosis; De novo donor-specific anti-HLA antibodies; Liver graft injury
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2022.09.007

This study investigated the association between different risk levels of de novo donor-specific anti-human leukocyte antigen antibodies (dnDSAs) and liver graft injury after liver transplantation in pediatric patients. This retrospective cohort study enrolled 130 patients after liver transplantation. Subjects were divided into the following 4 groups according to the mean fluorescence intensity (MFI) of dnDSAs: high risk group(MFI ≥10,000), medium risk group(4000 ≤ MFI <10,000), low risk group(500 ≤ MFI <4000), and negative group(<500). Liver function indices were examined along with liver puncture biopsy，and the relationship between dnDSA risk level and liver injury after transplantation was assessed. Pediatric liver transplant recipients showed significant differences in liver function (ALT, AST, GGT and Bilirubin) according to dnDSA risk level (P < 0.05), and no differences in cumulative incidences of rejection (P = 0.413) and liver fibrosis (P = 0.978) were observed among the number of dnDSAs group. There were differences in the cumulative incidences of antibody-mediated rejection (AMR) (P = 0.001) and T cell-mediated rejection （TCMR） (P = 0.003) across risk groups. The cumulative incidences of TCMR and liver fibrosis (P = 0.0001) were higher in the low-risk group than in the other 3 groups. There were no differences in graft survival rate (P = 0.846) across risk groups. DnDSAs in pediatric liver transplant recipients are associated with liver transplant rejection and fibrosis. The level of dnDSAs in low risk group should not be disregarded. Routine detection of dnDSAs has clinical utility for noninvasive risk stratification in this population. •Investigating the impact of dnDSAs on liver injury in pediatric liver transplantation.•Compared the cumulative incidences of rejection among high dnDSAs risk, medium dnDSAs risk, low dnDSAs risk and negative group.•Compared the cumulative incidences of liver fibrosis among high dnDSAs risk, medium dnDSAs risk, low dnDSAs risk and negative group.•Confirmed dnDSAs in pediatric liver transplant recipients are associated with liver transplant rejection and fibrosis. The level of dnDSAs in low risk group should not be disregarded.