Korean J Transplant.  2023 Nov;37(Suppl 1):S282. 10.4285/ATW2023.F-8977.

Prognostic potential: evaluating graft donor specific antibody and HLA antigen complexes in living-donor liver transplantation

• Kim M

• KMID: 2551911
• DOI: http://doi.org/10.4285/ATW2023.F-8977

Abstract

Background
Predicting clinical outcomes like rejection or biliary complications in liver transplant recipients with serum mismatched donor-specific antibodies (DSA) is difficult. This study aims to examine the correlation and outcomes of graft and serum DSA positive patients, utilizing immunocomplex capture fluorescence analysis (IFCA).
Methods
During liver transplantation, the donor graft specimen were reacted in vitro with the recipients serum. It was then dissolved in PBS using lysis buffer, and the HLA antigen-antibody complex was captured with anti-human leukocyte antigens (HLA) beads. Detection was performed using PE-conjugated anti-human IgG and analyzed using the Luminex system. The clinical outcomes of graft DSA positive and serum DSA positive patients were then compared.
Results
When the ratio of sample mean fluorescence intensity (MFI)/control MFI was defined as >1.5 for suspicious positive, and >2.0 for positive, out of 51 patients we examined, 12 were suspicious positive, and two were positive. None of these patients showed serum DSA positivity or acute cellular rejection or antibody-mediated rejection. Of these patients, seven had biliary complications, with six having biliary stricture and one biliary leakage. All biliary strictures were at the anastomosis site. Additionally, out of the total 51 patients, six were serum DSA positive, with no graft DSA positive among them. There was one case of antibody-mediated rejection, and two patients had bile duct anastomotic stricture. There was no clinical correlation between graft DSA positive patients and serum DSA positive patients.
Conclusions
Serum DSA and graft DSA are distinct tests, and the IFCA method may enable prediction of long-term graft damage before liver transplantation.