2017 Volume 24 Issue 2 Pages 134-142
The impact of donor-specific anti-HLA antibodies (DSA) on liver allograft is still elusive. The impact of DSA may cause two types of antibody-mediated rejection (AMR); one is acute AMR (aAMR) resulting in adverse consequences during the perioperative period, and the other is chronic AMR (cAMR) causing progressive fibrosis in the late liver allograft. Liver is believed to be, to some extent, resistant to AMR. However, the evidence has accumulated that preformed DSA will cause liver graft injury. We previously experienced that the one-year survival rate of the crossmatch positive patients was 60% without taking any measures. We assured the impact of high-MFI DSA on graft survival by retrospective analysis of DSA in the sera by solid-phase detection assay by Luminex. And then, we have adopted the new strategy for DSA-positive recipients to prevent acute AMR; avoidance of the donor whose HLA were target of DSA, or desensitization by rituximab. One year survival rate has improved to be similar among DSA-positive and negative recipients. The features of chronic AMR have not been well defined. We have reported that DSA are significantly correlated with progressive centrilobular fibrosis in the late allograft liver biopsies, especially in the pediatric recipients. The similar phenomena have been observed in the adult recipients. The impact of DSA on long-term prognosis is unclear from our experience, while the graft injury have been observed in the patients with DSA. The impact of preformed DSA on the survival has been emerged, however the strategy to prevent from fatal acute AMR and close follow-up for DSA-positive patients significantly improved the survival rate. Monitoring of DSA during perioperative period is important. De novo DSA are significantly correlated with progressive fibrosis, however, the influence on the prognosis of the graft in the DSA-positive patients should be revealed through long-term observation.
