Donor-specific antibodies in liver transplantation: challenges in diagnosis and determining clinical impact. Issue 6 (December 2020)

• Record Type: Journal Article
• Authors: Kim, Steven C.; Foley, David P.
• Is Part Of: Current opinion in organ transplantation. Volume 25:Issue 6(2020:Dec.)
• Publication Date: 2020-12
• Subjects: de-novo donor-specific antibodies -- donor-specific antibodies -- liver transplantation -- preformed donor-specific antibodies -- sensitization; Transplantation of organs, tissues, etc -- Periodicals; Immunosuppression -- Periodicals; Transplantation immunology -- Periodicals; 617.954
• DOI: 10.1097/MOT.0000000000000825
• Languages: English
• ISSNs: 1087-2418

Abstract

Abstract : Purpose of review: Our understanding of the clinical impact of donor-specific antibodies in liver transplant recipients has evolved in recent years as outcomes for liver allografts have improved and advances in diagnostic testing have made recognition of antibody mediated rejection in transplant patients more sensitive. Recent findings: Two main types of donor-specific antibodies – preformed and de novo – have been reported in the literature to have a negative impact on graft survival, and researchers have been able to further identify subclasses of class II donor-specific antibodies as being the most clinically impactful. Furthermore, there is evidence that donor-specific antibody formation can augment cellular rejection in liver grafts and lead to worsened clinical outcomes. Recent data have shown a higher prevalence of donor-specific antibody formation than previously reported. Summary: This review explores the most recent literature regarding the clinical impact of both preformed and de-novo donor-specific antibodies and potential management guidelines for patients undergoing liver transplantation. The best practice guidelines for undergoing monitoring for donor-specific antibody formation and protocol biopsies in sensitized patients will depend on further multiinstitutional studies.