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The role of donor-specific HLA alloantibodies in liver transplantation.

Publication ,  Journal Article
O'Leary, JG; Demetris, AJ; Friedman, LS; Gebel, HM; Halloran, PF; Kirk, AD; Knechtle, SJ; McDiarmid, SV; Shaked, A; Terasaki, PI; Tinckam, KJ ...
Published in: Am J Transplant
April 2014

The impact of donor-specific HLA alloantibodies (DSA) on short- and long-term liver transplant outcome is not clearly defined. While it is clear that not all levels of allosensitization produce overt clinical injury, and that liver allografts possess some degree of alloantibody resistance, alloantibody-mediated adverse consequences are increasingly being recognized. To better define the current state of this topic, we assembled experts to provide insights, explore controversies and develop recommendations for future research on the consequences of DSA in liver transplantation. This article summarizes the proceedings of this inaugural meeting. Several insights emerged. Acute antibody-mediated rejection (AMR), although rarely diagnosed, is increasingly understood to overlap with T cell-mediated rejection. Isolated liver allograft recipients are at increased risk of early allograft immunologic injury when preformed DSA are high titer and persist posttransplantation. Persons who undergo simultaneous liver-kidney transplantation are at risk of renal AMR when Class II DSA persist posttransplantation. Other under-appreciated DSA associations include ductopenia and fibrosis, plasma cell hepatitis, biliary strictures and accelerated fibrosis associated with recurrent liver disease. Standardized DSA testing and diagnostic criteria for both acute and chronic AMR are needed to distil existing associations into etiological processes in order to develop responsive therapeutic strategies.

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Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

April 2014

Volume

14

Issue

4

Start / End Page

779 / 787

Location

United States

Related Subject Headings

  • Tissue Donors
  • Surgery
  • Research Report
  • Prognosis
  • Practice Guidelines as Topic
  • Liver Transplantation
  • Liver Diseases
  • Isoantibodies
  • Humans
  • HLA Antigens
 

Citation

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MLA
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O’Leary, J. G., Demetris, A. J., Friedman, L. S., Gebel, H. M., Halloran, P. F., Kirk, A. D., … Klintmalm, G. B. (2014). The role of donor-specific HLA alloantibodies in liver transplantation. Am J Transplant, 14(4), 779–787. https://doi.org/10.1111/ajt.12667
O’Leary, J. G., A. J. Demetris, L. S. Friedman, H. M. Gebel, P. F. Halloran, A. D. Kirk, S. J. Knechtle, et al. “The role of donor-specific HLA alloantibodies in liver transplantation.Am J Transplant 14, no. 4 (April 2014): 779–87. https://doi.org/10.1111/ajt.12667.
O’Leary JG, Demetris AJ, Friedman LS, Gebel HM, Halloran PF, Kirk AD, et al. The role of donor-specific HLA alloantibodies in liver transplantation. Am J Transplant. 2014 Apr;14(4):779–87.
O’Leary, J. G., et al. “The role of donor-specific HLA alloantibodies in liver transplantation.Am J Transplant, vol. 14, no. 4, Apr. 2014, pp. 779–87. Pubmed, doi:10.1111/ajt.12667.
O’Leary JG, Demetris AJ, Friedman LS, Gebel HM, Halloran PF, Kirk AD, Knechtle SJ, McDiarmid SV, Shaked A, Terasaki PI, Tinckam KJ, Tomlanovich SJ, Wood KJ, Woodle ES, Zachary AA, Klintmalm GB. The role of donor-specific HLA alloantibodies in liver transplantation. Am J Transplant. 2014 Apr;14(4):779–787.
Journal cover image

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

April 2014

Volume

14

Issue

4

Start / End Page

779 / 787

Location

United States

Related Subject Headings

  • Tissue Donors
  • Surgery
  • Research Report
  • Prognosis
  • Practice Guidelines as Topic
  • Liver Transplantation
  • Liver Diseases
  • Isoantibodies
  • Humans
  • HLA Antigens