Preformed antibodies detected by cytotoxic assay or multibead array decrease liver allograft survival: role of human...

Area of Science:

• Immunology
• Transplantation Medicine
• Genetics

Background:

• Human leukocyte antigen (HLA) compatibility and preformed antibodies are critical factors in organ transplantation, but their precise impact on liver graft survival requires further elucidation.
• Assessing donor-recipient HLA matching and the presence of preformed antibodies is essential for predicting transplant outcomes.

Purpose of the Study:

• To evaluate the influence of donor-recipient HLA compatibility and preformed antibodies on graft survival in a large cohort of liver transplant recipients.
• To compare the efficacy of complement-dependent cytotoxicity (CDC) and Luminex xMAP assays in detecting preformed antibodies and their association with transplant outcomes.

Main Methods:

• A single-center cohort study involving 896 liver transplants was analyzed.
• Kaplan-Meier survival analysis was used to assess the impact of HLA compatibility and preformed antibodies on allograft survival.
• Concordance between CDC and Luminex xMAP assays for antibody detection was evaluated.

Main Results:

• Donor-recipient HLA compatibility showed a marginal impact on overall allograft survival.
• Two mismatches at the HLA-A locus were associated with improved survival in retransplanted grafts.
• Preformed antibodies detected by both CDC and Luminex were significantly associated with shorter graft survival within the first year post-transplant.
• Positive CDC T crossmatches and Luminex-detected HLA class II antibodies were linked to decreased graft survival at both 1 and 5 years.
• The presence of preformed Luminex-detected antibodies correlated with an increased risk of allograft rejection.

Conclusions:

• While HLA typing may not be a prerequisite for liver transplantation, screening for HLA antibodies using Luminex techniques and performing CDC crossmatches can identify high-risk patients.
• Early detection of at-risk patients allows for intensified surveillance and personalized therapeutic strategies to improve graft survival.