Humoral immunity emerges as a risk factor for graft failure after visceral transplantation (VTx) and development of donor-specific anti-HLA antibodies (DSAs) has been linked with poor outcomes. In most cases, a simultaneous liver transplant can be safely performed in sensitized patients with DSA and appears protective against lymphocytotoxic antibodies. We investigated the incidence of acute (AR) and chronic rejection (CR) in 32 VTx without any B cell-depleting pre-treatment (6 isolated intestinal transplants (IT) and 26 liver-containing, multivisceral transplants (MVT) and assessed the presence of donor-specific antibodies (DSA) pre- and post-transplantation. Twenty-one patients (65 %) developed AR, 15 (57 %) of the MVT and 6 (100 %) of the IT (p = 0.05). CR occurred in 4 IT (60 %, p < 0.001). At one month, DSA were present in 71 % of VTx (66 % MVT vs 100 % IT, p = 0.09). At the last available follow-up, 69 % of the MVT and 50 % of the IT patients were DSA-free. D DSA seemed more persistent (7/19, 37 %) than pre-Tx DSA (1/6, 17 %; p = n.s.), DSA were more frequently specific for HLA class II than class I, 16/19 (84 %) vs. 7/19 (37 %; p = 0.003), and HLA-DQ was their most frequent target HLA. DQ mismatches appeared to be a risk factor for developing DSA. In conclusion, liver-containing visceral allografts have superior short- and long-term outcomes compared with liver-free allografts. DSA develop early and frequently after VTx performed without B cell-depleting induction therapy, but the exact role of DSA in the pathogenesis of rejection remains unclear.

中文翻译：

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将肝脏纳入内脏同种异体移植物中：对供体特异性抗 HLA 抗体和长期结果的影响

体液免疫成为内脏移植 (VTx) 后移植失败的危险因素，而供体特异性抗 HLA 抗体 (DSA) 的产生与不良预后相关。在大多数情况下，DSA 致敏患者可以安全地同时进行肝移植，并且可以预防淋巴细胞毒性抗体。我们调查了 32 例未经任何 B 细胞耗竭预处理的 VTx（6 例离体肠移植 (IT) 和 26 例含肝脏多内脏移植 (MVT)）中急性 (AR) 和慢性排斥 (CR) 的发生率，并评估了是否存在移植前和移植后供体特异性抗体 (DSA) 的变化。21 名患者 (65%) 出现 AR，15 名患者 (57%) 出现 MVT，6 名患者 (100%) 出现 IT (p = 0.05)。发生在 4 例 IT 中（60 %，p < 0.001）。一个月时，71 % 的 VTx 中存在 DSA（66 % MVT 对比 100 % IT，p = 0.09）。在最后一次随访时，69 % 的 VTx 出现 DSA。 MVT 和 50 % 的 IT 患者没有 DSA。D DSA 似乎比 Tx 前 DSA (1/6, 17 %; p = ns) 更持久 (7/19, 37 %)，DSA 更频繁地具有特异性HLA II 类的比例高于 I 类，16/19 (84%) vs. 7/19 (3​​7%；p = 0.003)，并且 HLA-DQ 是他们最常见的目标 HLA。DQ 不匹配似乎是发展的风险因素DSA. 总之，与无肝同种异体移植物相比，含肝内脏同种异体移植物具有更好的短期和长期结果。DSA 在未进行 B 细胞耗竭诱导治疗的 VTx 后早期且频繁地发生，但 DSA 在排斥反应发病机制中的确切作用仍不清楚。