THE LACK OF LONG-TERM DETRIMENTAL EFFECTS ON LIVER ALLOGRAFTS CAUSED BY DONOR-SPECIFIC ANTI-HLA ANTIBODIES

Recent reports indicate a higher incidence of both acute and chronic l iver allograft rejection when, at the time of transplantation, the rec ipients serum contains donor-specific anti-HLA antibodies. From 9/89 t o 5/91, 133 liver allografts were performed at our institution. Thirte en liver recipients had donor-specific IgG anti-HLA antibodies (comple ment-fixing) at the time of transplantation. In eleven patients, antib odies reacted to donor class I antigens while in 1 patient the donor-s pecific antibody had class II reactivity. Twelve patients have been fo llowed for a minimum of 12 months (median 18 months, range 28-12 month s). No hyperacute rejection was seen in any of the cases and four pati ents had acute rejections. Thus far only one of the twelve patients ha s biopsy evidence suggestive of chronic liver injury. The remaining ha ve normal liver enzymes and bilirubin. Three of these twelve patients died (one from a myocardial infarction and the others from sepsis) acc ounting for a one-year graft survival of 75%. There was no significant statistical difference in the one-year graft survival in those recipi ents without donor-specific antibodies (i.e., 80.5%). In eight of the twelve patients, pretransplant preformed antibody level (PRA) was >50% . In six of the thirteen patients donor-specific antibody was present at dilutions greater than 1:64. As previously reported, the donor-spec ific antibody disappeared from the serum posttransplant within hours a nd did not reappear. In vitro studies demonstrated no factor in portal or hepatic artery blood that could inhibit rabbit complement mediated lysis of anti-HLA antibodies. We conclude that it is not a contraindi cation to do liver transplants in the presence of donor-specific anti- HLA antibodies.