The impact of alloantibodies directed against the second donor on long-term outcomes of repeat liver transplantation

作     者：Qingyong Xu Brad Shrum Steve Leckie Anton Skaro Vivian C.McAlister 

作者机构：Department of Pathology and Lab MedicineUniversity of Western OntarioLondonONCanada Department of SurgeryUniversity of Western OntarioLondonONCanada 

出 版 物：《Hepatobiliary Surgery and Nutrition》 (肝胆外科与营养（英文）)

年 卷 期：2019年第8卷第3期

页      面：246-252页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Donor-specific antibodies(DSA) human leucocytes antigen(HLA) liver transplantation 

摘      要：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 ***-transplantation provides a test environment where the presence of preformed DSA is prevalent and its effect on outcome should be ***:All patients undergoing a second liver transplantation with available pre-operative serum were included with the exception of ABO incompatible or multiple organ *** sera were tested for anti-HLA antibodies with Luminex-based solid phase ***-HLA antibodies to the second donor(D2SA)were determined using antibodies specificity and HLA typing of 2nd liver ***:Preformed HLA antibodies directed to second liver transplantation(D2SA)were found in 31(39%)of the 79 patients that were included in the *** and re-transplantation characteristics were similar in both subgroups except first graft survival which was significantly shorter in recipients who are negative for *** 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 *** 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 ***: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 requ