Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 27, 2021; 13(6): 673-685
Published online Jun 27, 2021. doi: 10.4254/wjh.v13.i6.673
Impact of donor-specific antibodies on long-term graft survival with pediatric liver transplantation
Felicitas Leonie Schotters, Jan Beime, Andrea Briem-Richter, Thomas Binder, Uta Herden, Enke Freya Grabhorn
Felicitas Leonie Schotters, Jan Beime, Andrea Briem-Richter, Enke Freya Grabhorn, Department of Pediatric Hepatology and Liver Transplantation, Universitätsklinikum Hamburg-Eppendorf, Hamburg 20246, Germany
Thomas Binder, Department of Transfusion Medicine, Human Leucocyte Antigen Laboratory, University Medicine Rostock, Rostock 18057, Germany
Uta Herden, Department of Hepatobiliary & Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, Hamburg 20246, Germany
Author contributions: Schotters FL participated in research design, performed the data collection, performed the research and data analysis, created figures and tables and wrote the paper; Beime J performed a critical revision and participated in writing the manuscript; Briem-Richter A participated in research design; Binder T performed a critical revision; Herden U performed a critical revision; Grabhorn E participated in research design, writing the manuscript, performance of the research and supervised the report.
Institutional review board statement: Our study was approved by the responsible ethics committee.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Enke Freya Grabhorn, MD, Attending Doctor, Department of Pediatric Hepatology and Liver Transplantation, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Hamburg 20246, Germany.
Received: January 8, 2021
Peer-review started: January 8, 2021
First decision: March 29, 2021
Revised: April 12, 2021
Accepted: May 21, 2021
Article in press: May 21, 2021
Published online: June 27, 2021
Processing time: 148 Days and 4.6 Hours
Research background

An impact of donor-specific antibodies (DSAs) on long-term liver allograft survival was found previously in a small cohort of pediatric patients, but the statistical significance was unclear.

Research motivation

The aim of this study was to clarify the importance of DSAs on long-term graft survival in a larger cohort of pediatric patients.

Research objectives

The objective of this study was to emphasize the importance of comprehensive follow-up examinations in clinical practice after pediatric liver transplantation (LT) and contribute to optimizing and standardizing LT follow-ups.

Research methods

This was a cross-sectional retrospective cohort study that compared the outcomes of two patient groups after pediatric LT.

Research results

Our study showed that DSAs significantly impact liver allograft survival. The presence of human leucocyte antigen class II DSAs is associated with chronic rejection, chronic antibody-mediated rejection, graft fibrosis, graft failure, graft loss and re-LT.

Research conclusions

Screening of DSAs and protocol liver biopsies including C4d immunostaining should be standard practice in follow-ups after pediatric LT.

Research perspectives

Further prospective studies should be conducted to explore whether certain DQ-DSAs could be used as a serological marker for the risk of graft loss.