Evidence that alloantibody is a major risk factor for graft loss and death in living-donor liver transplantation

Abstract

LEUKOCYTE ANTIGENS (HLA) (ALLOANTIBODY) are identified as a major risk factor for early graft damage and graft loss in kidney and heart transplant recipients. Common belief has been, however, that a liver transplant with its vast endothelial surface is capable of absorbing large quantities of alloantibody without deleterious effects. Indeed, at least 1 group has employed a protocol involving an auxiliary partial liver transplant in order to absorb alloantibody and allow successful kidney transplantation in highly allosensitized renal transplant recipients. Living donor liver transplantation (LDLTx) is an increasingly successful alternative to deceased donor liver transplantation. In countries such as Japan, where deceased donation rates are extremely low due to societal constraints, LDLTx may be the only therapeutic option. In this issue of Surgery, Hori et al describe their experience with LDLTx (1167 transplants between January 1996 and June 2009). Anti-donor alloantibody was determined by a lymphocyte cytotoxicity assay (a relatively insensitive assay that detects primarily anti-Class I antibody but not anti-Class II). Thirty patients were LCM+/blood group compatible, 171 were LCM-/blood group incompatible, 4 were both LCM+/blood group incompatible, and 952 were both LCM-/blood group compatible. Their results suggest that the outcomes of LCM+ recipients are significantly worse than those in LCMpatients; indeed, 12% (4/34) of LCM+ recipients required retransplantation due to allograft failure. Late patient survival was significantly less in the LCM+ group, with 40% (15/34) dying