AI Article Synopsis
- Antibody-mediated rejection is a growing concern in liver transplantation, specifically regarding donor-specific antibodies (DSAs) and their effects on graft survival, with a lack of research on pediatric populations.
- A study involving 67 pediatric liver transplant recipients identified that 28.3% had pre-transplant DSAs, while 48.4% developed them post-transplant, and rejection episodes were confirmed in 13 patients.
- The presence of post-transplant DSAs significantly increased the risk of rejection, underscoring the need to include DSA monitoring in the care of pediatric liver transplant patients.
Article Abstract
Background: Antibody-mediated rejection following liver transplantation (LT) has been increasingly recognized, particularly with respect to the emergence of donor-specific antibodies (DSAs) and their impact on graft longevity. While substantial evidence for adult populations exists, research focusing on pediatric LT outcomes remains limited.
Aim: To investigate the prevalence of human leukocyte antigen (HLA) mismatches and DSA and evaluate their association with rejection episodes after pediatric LT.
Methods: A cohort of pediatric LT recipients underwent HLA testing at Santa Casa de Porto Alegre, Brazil, between December 2013 and December 2023. Only patients who survived for > 30 days after LT with at least one DSA analysis were included. DSA classes I and II and cross-matches were analyzed. The presence of DSA (dnDSA) was evaluated at least 3 months after LT using the Luminex single antigen bead method, with a positive reaction threshold set at 1000 MFI. Rejection episodes were confirmed by liver biopsy.
Results: Overall, 67 transplanted children were analyzed; 61 received grafts from living donors, 85% of whom were related to recipients. Pre-transplant DSA (class I or II) was detected in 28.3% of patients, and dnDSA was detected in 48.4%. The median time to DSA detection after LT was 19.7 [interquartile range (IQR): 4.3-35.6] months. Biopsy-proven rejection occurred in 13 patients at follow-up, with C4d positivity observed in 5/13 Liver biopsies. The median time to rejection was 7.8 (IQR: 5.7-12.8) months. The presence of dnDSA was significantly associated with rejection (36% 3%, < 0.001). The rejection-free survival rates at 12 and 24 months were 76% 100% and 58% 95% for patients with dnDSA anti-DQ those without, respectively.
Conclusion: Our findings highlight the importance of incorporating DSA assessment into pre- and post-transplantation protocols for pediatric LT recipients. Future implications may include immunosuppression minimization strategies based on this analysis in pediatric LT recipients.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438625 | PMC |
| http://dx.doi.org/10.3748/wjg.v30.i33.3837 | DOI Listing |
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