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Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation

Donor-specific anti-human leukocyte antigen antibodies (DSA) are controversially discussed in the context of liver transplantation (LT). We investigated the relationship between the presence of DSA and the outcome after LT. All the LTs performed at our center between 1 January 2008 and 31 December 2...

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Autores principales: Ünlü, Sinem, Lachmann, Nils, Jara, Maximilian, Ritschl, Paul Viktor, Wiering, Leke, Eurich, Dennis, Denecke, Christian, Biebl, Matthias, Chopra, Sascha, Gül-Klein, Safak, Schöning, Wenzel, Schmelzle, Moritz, Reinke, Petra, Tacke, Frank, Pratschke, Johann, Öllinger, Robert, Dziodzio, Tomasz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763868/
https://www.ncbi.nlm.nih.gov/pubmed/33317012
http://dx.doi.org/10.3390/jcm9123986
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author Ünlü, Sinem
Lachmann, Nils
Jara, Maximilian
Ritschl, Paul Viktor
Wiering, Leke
Eurich, Dennis
Denecke, Christian
Biebl, Matthias
Chopra, Sascha
Gül-Klein, Safak
Schöning, Wenzel
Schmelzle, Moritz
Reinke, Petra
Tacke, Frank
Pratschke, Johann
Öllinger, Robert
Dziodzio, Tomasz
author_facet Ünlü, Sinem
Lachmann, Nils
Jara, Maximilian
Ritschl, Paul Viktor
Wiering, Leke
Eurich, Dennis
Denecke, Christian
Biebl, Matthias
Chopra, Sascha
Gül-Klein, Safak
Schöning, Wenzel
Schmelzle, Moritz
Reinke, Petra
Tacke, Frank
Pratschke, Johann
Öllinger, Robert
Dziodzio, Tomasz
author_sort Ünlü, Sinem
collection PubMed
description Donor-specific anti-human leukocyte antigen antibodies (DSA) are controversially discussed in the context of liver transplantation (LT). We investigated the relationship between the presence of DSA and the outcome after LT. All the LTs performed at our center between 1 January 2008 and 31 December 2015 were examined. Recipients < 18 years, living donor-, combined, high-urgency-, and re-transplantations were excluded. Out of 510 LTs, 113 DSA-positive cases were propensity score-matched with DSA-negative cases based on the components of the Balance of Risk score. One-, three-, and five-year survival after LT were 74.3% in DSA-positive vs. 84.8% (p = 0.053) in DSA-negative recipients, 71.8% vs. 71.5% (p = 0.821), and 69.3% vs. 64.9% (p = 0.818), respectively. Rejection therapy was more often applied to DSA-positive recipients (n = 77 (68.1%) vs. 37 (32.7%) in the control group, p < 0.001). At one year after LT, 9.7% of DSA-positive patients died due to sepsis compared to 1.8% in the DSA-negative group (p = 0.046). The remaining causes of death were comparable in both groups (cardiovascular 6.2% vs. 8.0%; p = 0.692; hepatic 3.5% vs. 2.7%, p = 0.788; malignancy 3.5% vs. 2.7%, p = 0.788). DSA seem to have an indirect effect on the outcome of adult LTs, impacting decision-making in post-transplant immunosuppression and rejection therapies and ultimately increasing mortality due to infectious complications.
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spelling pubmed-77638682020-12-27 Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation Ünlü, Sinem Lachmann, Nils Jara, Maximilian Ritschl, Paul Viktor Wiering, Leke Eurich, Dennis Denecke, Christian Biebl, Matthias Chopra, Sascha Gül-Klein, Safak Schöning, Wenzel Schmelzle, Moritz Reinke, Petra Tacke, Frank Pratschke, Johann Öllinger, Robert Dziodzio, Tomasz J Clin Med Article Donor-specific anti-human leukocyte antigen antibodies (DSA) are controversially discussed in the context of liver transplantation (LT). We investigated the relationship between the presence of DSA and the outcome after LT. All the LTs performed at our center between 1 January 2008 and 31 December 2015 were examined. Recipients < 18 years, living donor-, combined, high-urgency-, and re-transplantations were excluded. Out of 510 LTs, 113 DSA-positive cases were propensity score-matched with DSA-negative cases based on the components of the Balance of Risk score. One-, three-, and five-year survival after LT were 74.3% in DSA-positive vs. 84.8% (p = 0.053) in DSA-negative recipients, 71.8% vs. 71.5% (p = 0.821), and 69.3% vs. 64.9% (p = 0.818), respectively. Rejection therapy was more often applied to DSA-positive recipients (n = 77 (68.1%) vs. 37 (32.7%) in the control group, p < 0.001). At one year after LT, 9.7% of DSA-positive patients died due to sepsis compared to 1.8% in the DSA-negative group (p = 0.046). The remaining causes of death were comparable in both groups (cardiovascular 6.2% vs. 8.0%; p = 0.692; hepatic 3.5% vs. 2.7%, p = 0.788; malignancy 3.5% vs. 2.7%, p = 0.788). DSA seem to have an indirect effect on the outcome of adult LTs, impacting decision-making in post-transplant immunosuppression and rejection therapies and ultimately increasing mortality due to infectious complications. MDPI 2020-12-09 /pmc/articles/PMC7763868/ /pubmed/33317012 http://dx.doi.org/10.3390/jcm9123986 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ünlü, Sinem
Lachmann, Nils
Jara, Maximilian
Ritschl, Paul Viktor
Wiering, Leke
Eurich, Dennis
Denecke, Christian
Biebl, Matthias
Chopra, Sascha
Gül-Klein, Safak
Schöning, Wenzel
Schmelzle, Moritz
Reinke, Petra
Tacke, Frank
Pratschke, Johann
Öllinger, Robert
Dziodzio, Tomasz
Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation
title Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation
title_full Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation
title_fullStr Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation
title_full_unstemmed Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation
title_short Treatment of Anti-HLA Donor-Specific Antibodies Results in Increased Infectious Complications and Impairs Survival after Liver Transplantation
title_sort treatment of anti-hla donor-specific antibodies results in increased infectious complications and impairs survival after liver transplantation
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763868/
https://www.ncbi.nlm.nih.gov/pubmed/33317012
http://dx.doi.org/10.3390/jcm9123986
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