The Clinical Research Of Donor Specific Antibody In Liver Transplantation

Objective To analysis the risk factors, prevalence and effect of donor specific antibody in liver transplantation,and discusses therapeutic schemes. Methods We retrospectively analyzed prospectively collected samples from 139 cases of liver transplantation from September 1,2013 to July 1,2015.Luminex? assays determines panel reactive antibody(PRA).PRA positive cases, continued to analyze DSA, C1 q,C4d and liver biopsy. Results There were 139 cases included, 4 cases died early time(post-liver transplantation 24day?12day?3day?5day)The median follow-up period of the rest was 15.3months, ranging from 1.1-29.5months after liver transplantation, 12 patients had DSAs, including 2 Pre DSA : ? DSA, HLA-A mismatch;2?DSA, HLA-DQ mismatch; The 10 de novo DSAs all were HLA-DQ mismatch(including 1 Pre DSA),The incidence of de novo DSA is 7.19%.5 cases liver biopsy showed hepatic fibrosis, early rejection and intrahepatic cholestasis.5cases showed DSA and C1 q positive. Mycophenolate mofetil could reduce the risk of DSA(P = 0.017),the same as pediatric patients(P = 0.025),base on FK506( tacrolimus) and methylprednisolone.91.7% of the DSA patiengts showed the mismatch of HLA-DQ.But induction therapy has no obvious effect on the DSA(P =0.110).The therapy of DSA included adjusting FK506 dose to target level.Base on FK506,increasing or adding the use of mycophenolate mofetil,methylprednisolone and immunoglobulin(IVIG). Conclusions DSA are important indicator of sensitized recipients in liver transplantation.DSA have significantly influence on recipients and graft in liver transplantation. The monitor of DSA is requisite,in order to adjust the immunosuppressant.