Antibody-Mediated Rejection and Graft Outcome in ABO-Compatible Liver Re-Transplantation.
Sharif Ali, Veena Shah, Kristin Kantz, Alison VanDyke, Meredith Mahan, Sharon Skorupski, Bradly Eisenbery, Ileana Lopez-Plaza, Gerebi Rada, Adrian Ormsby. Henry Ford Hospital, Detroit, MI
Background: Unlike kidney, the role of HLA antibody mediated rejection (AMR) in ABO-compatible liver transplantation is still controversial. Limited reports described isolated episodes of AMR with early graft loss requiring re-transplantation (re-tx) despite aggressive therapy. We conducted a retrospective study of re-transplanted patients (pts) to explore similar incidence and effect on transplantation outcome.
Design: Fifty four of 63 Pts who underwent ABO-compatible/identical orthotropic liver re-tx since May 2004 were selected. Pts were classified based on time to graft failure into group; (A) primary non-function graft or graft loss within the first 7 days (ds) from transplantation; (B) re-tx pts within 8-90 ds and (C) re-tx pts > 91 ds. The latter was chosen sequentially based on the UNOS registration number. 142 graft biopsies and hepatectomy specimens were selected for histological review and C4d staining including all time zero biopsies, graft hepatectomies and post-transplant biopsies. The association between predictor values and graft survival were assessed using ordinal models for multinomial data. Repeated-measures logistic regression was used to examine the association between C4d staining and graft survival. All analyses were completed using SAS 9.2.
Results: All 7 pts met our group A criterion, 12/14 pts in group B and 35/42 were included in group C. Pts demographics: 36 M/18 F, mean 51 years (range 19-71). Elevated native liver ALT, AST, and INR levels prior to transplantation were significantly and negatively associated with first graft survival (p = 0.01, <0.0001, and 0.03, respectively); however, only AST remained significant after combining three parameters (p = 0.003). Albumin levels, ALK, graft cold and warm ischemic time, C4d staining, and HLA class I/II mismatch antigens did not impact graft survival (p-values >0.05). fourteen grafts demonstrated possible evidence of AMR after excluding other causes based on the NIH published consensus. DSA were documented in 13 of them using flow-PRA single antigen beads and anti-human globulin CDC T-cell trays. C4d endothelial and sinusoidal staining was noted in 6/11, 2/2 and 10/23 of specimens with acute cellular rejection (ACR), chronic ductopenic rejection and recurrent HCV, respectively.
Conclusions: Our findings support the concept that liver naturally resists AMR and its impact remains limited to few reported cases. In our cohort elevated native liver ALT, AST and INR made a negative impact on early graft survival. C4d expression, unlike other allografts, is not a predictor of AMR as it can be seen in various other conditions.
Category: Liver & Pancreas
Wednesday, March 2, 2011 9:30 AM
Poster Session V # 191, Wednesday Morning