ANTI HLA ANTIBODIES INCREASE ALLOGRAFT REJECTION AND GRAFT LOSS FOLLOWING LIVER TRANSPLANTATION
Amal Bishara, Chaim Brautbar, Ahmed Eid, Lenny Sherman, Yaron Ilan and Rifaat Safadi Tissue Typing Unit, Lautenberg Center for General & Tumor Immunology, Dept. Surgery and Liver Unit, Hadassah University Hospital, Jerusalem, Israel.
The impact of positive crossmatch (CM) on liver transplantation (LT) outcome is still controversial. In the present study we compared incidence of early graft loss, rejection episodes, post LT complications and patient and graft survival rates between positive (n=14) and negative (n=36) pre-transplant CM liver recipients. CMs were performed by the CDC test using DTT treated sera. Sera were screened for the presence of anti HLA class I and class II antibodies utilizing One Lambda Antigen Tray - Mixed (LATTM) by means of ELISA. Early graft losses, rejection episodes within the first 3 months post LT and chronic rejections were associated with positive CM (P=0.029, P=0.05 and P=0.02, respectively). Graft survival was better in the negative CM group. Patients' survival was similar in both groups. As determined by ELISA, PRA analysis was positive in 35 and negative in 15 recipients. 4/35 positive PRA recipients lost their graft in the first week post LT as compared to none in the negative PRA group, more frequent rejection episodes in the first 3 months post LT were observed in the positive as compared to negative PRA group (P=0.01). The effect of positive PRA on LT outcome was more profound in the negative CM group (P=0.005). PRA was associated with post LT complications (P=0.039). We conclude that anti HLA antibodies had deleterious effect on liver transplantation outcome and are associated with increase incidence of early graft loss and rejection episodes.