Abstract
BackgroundThe impact of de novo anti-HLA donor-specific alloantibodies (DSA) which develop after long-term liver transplantation (LT) remains controversial and unclear. The aim of this study was to investigate the role of de novo DSAs on the outcome in LT.MethodsWe did a systematic review and meta-analysis of observational studies published until Dec 31, 2019, that reported de novo DSA outcome data (≥1 year of follow-up) after liver transplant. A literature search in the MEDLINE/PubMed, EMBASE, Cochrane Library, Scopus and Web of Science Core Collection databases was performed.ResultsOf 5,325 studies identified, 15 fulfilled our inclusion criteria. The studies which reported 2016 liver transplant recipients with de novo DSAs showed an increased complication risk, i.e. graft loss and chronic rejection (OR 3.61; 95% CI 1.94–6.71, P < 0.001; I2 58.19%), and allograft rejection alone (OR 6.43; 95% CI: 3.17–13.04; P < 0.001; I2 49.77%); they were compared to patients without de novo DSAs. The association between de novo DSAs and overall outcome failure was consistent across all subgroups and sensitivity analysis.ConclusionsOur study suggested that de novo DSAs had a significant deleterious impact on the liver transplant risk of rejection. The routine detection of de novo DSAs may be beneficial as noninvasive biomarker-guided risk stratification.
Highlights
The damaging effect of alloantibodies against donor Human leukocyte antigen (HLA) has been widely known in all solid organ transplantation, except the liver [1, 2]
The latest studies suggested the possible impact of de novo donor specific antibodies (dn-donor-specific alloantibodies (DSA)) and the humoral response as a risk factor for unexplained post-operative complications such as biliary problems, acute and chronic rejection, and patient survival, especially in deceased-donor liver transplantation (DDLT) compared to living donor liver transplantation (LDLT) [22,23,24,25,26,27]
Uncertainty about the role of dn-DSAs after liver transplantation in humoral response still exists, and dn-DSA monitoring has not been universally adopted by all transplant centers in LT recipients [27, 29]
Summary
The damaging effect of alloantibodies against donor HLA has been widely known in all solid organ transplantation, except the liver [1, 2]. In liver transplant (LT) recipients, the first reports failed to reveal an association between dn-DSAs and graft rejection or survival [13,14,15]. Further reports demonstrate that LT recipients who develop dn-DSA reveal lower graft and patient survival [20, 21]. The latest studies suggested the possible impact of dn-DSA and the humoral response as a risk factor for unexplained post-operative complications such as biliary problems, acute and chronic rejection, and patient survival, especially in deceased-donor liver transplantation (DDLT) compared to living donor liver transplantation (LDLT) [22,23,24,25,26,27]. The impact of de novo anti-HLA donor-specific alloantibodies (DSA) which develop after long-term liver transplantation (LT) remains controversial and unclear.
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