Donor specific HLA Antibodies as a Trigger for Ischemic Type Biliary Lesions (ITBL) after Orthotopic Liver Transplantation-A Case Controlled Study

Abstract

Despite recent surgical developments, biliary complications following orthotopic liver transplantation (OLT) are an important cause of morbidity and mortality. Ischemic Type Biliary Lesions (ITBL) is particularly challenging accounting for a high proportion of bile-duct associated complications following OLT. We aimed to better predict and reduce the incidence of ITBL through detection of donor specific human leucocyte antibodies (DSA). These could be involved in the pathogenesis of this disease. This approach allows to standardized perioperative DSA-screening in OLT-patients.Prospective database of ITBL-patients (n=15) that had undergone OLT from February 2008 to October 2011 was analysed. Clinical parameters, biochemical data including preoperative HLA-status and postoperative DSA-status, complications, morbidity and mortality were studied. The ITBL-patients were matched in a 1:1 ratio accounting for demographic and clinical variables to a control cohort of OLT-patients. Propensity modelling with matched cohort analysis was employed. There was a significance between the detection of de novo DSA and the development of an ITBL (p=0,003) and an asymptomatic elevation of alkaline phosphatase (AP). This suggested a strong relationship between de novo DSA and future development of ITBL. This implies a need for a protocolisation of care with standardized postoperative DSA-status allowing earlier diagnosis and therapeutic intervention.