Cargando…
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...
Autores principales: | , , , , , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783628120487624704 |
---|---|
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. |
format | Online Article Text |
id | pubmed-7763868 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT unlusinem treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT lachmannnils treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT jaramaximilian treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT ritschlpaulviktor treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT wieringleke treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT eurichdennis treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT deneckechristian treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT bieblmatthias treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT choprasascha treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT gulkleinsafak treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT schoningwenzel treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT schmelzlemoritz treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT reinkepetra treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT tackefrank treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT pratschkejohann treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT ollingerrobert treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation AT dziodziotomasz treatmentofantihladonorspecificantibodiesresultsinincreasedinfectiouscomplicationsandimpairssurvivalafterlivertransplantation |