Donor-Specific Antibodies and liver transplantation

Abstract In contrast to other types of organ transplantation, liver-transplant recipients used to be considered highly resistant to donor-specific antibodies (DSAs). Consequently, most transplant programs did not consider the presence of DSAs at transplantation or during the follow-up. However, sinc...

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Bibliographic Details
Published in:Human immunology 2016-11, Vol.77 (11), p.1063-1070
Main Authors: Bello, Arnaud Del, Congy-Jolivet, Nicolas, Danjoux, Marie, Muscari, Fabrice, Kamar, Nassim
Format: Article
Language:English
Subjects:
Allergy and Immunology
Antibody-Dependent Cell Cytotoxicity
Antibody-mediated rejection
Donor-specific antibodies
Graft Rejection - immunology
HLA Antigens - immunology
Humans
Humoral response
Immunity, Humoral
Isoantibodies - metabolism
Liver Transplantation
Organ Specificity
Transplantation Immunology
Treatment
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Summary:Abstract In contrast to other types of organ transplantation, liver-transplant recipients used to be considered highly resistant to donor-specific antibodies (DSAs). Consequently, most transplant programs did not consider the presence of DSAs at transplantation or during the follow-up. However, since the early 1990s, antibody-mediated pathological lesions have been recognized in ABO-incompatible liver-transplant recipients. Recent data confirm the detrimental effect of preformed and de novo DSAs in ABO-compatible liver transplantation, with inferior clinical outcomes in patients presenting with circulating antibodies. Acute antibody-mediated rejection (AMR), plasma-cell hepatitis, biliary stricture, but also long-term complications, such as chronic rejection, liver ductopenia, and graft fibrosis, are now recognized to be associated with DSAs. Moreover, some non-HLA DSAs are suspected to induce graft dysfunction. Clinical, biological, and histological patterns within AMR need to be clarified. Treatment of these complications has yet to be defined. This article summarizes recent advances concerning the impact of preformed and de novo DSAs in liver transplantation, it defines the complications associated with DSAs, and discusses the potential strategies to manage patients with such complications.
ISSN:0198-8859
1879-1166
DOI:10.1016/j.humimm.2016.02.006