Pregnancy and donor-specific HLA-antibody-mediated rejection after liver transplantation: "Liaisons dangereuses"?

Transpl Immunol. 2019 Jun:54:47-51. doi: 10.1016/j.trim.2019.02.002. Epub 2019 Feb 8.

Abstract

Background: Risk factors for the development of anti-HLA antibodies include blood transfusion, organ transplantation, and pregnancy. Humoral rejection, mediated by donor-specific anti-HLA antibodies (DSA), has been studied in all kind of solid organ transplantations, and several studies have suggested that post-liver transplantation (LT) DSA may play a role in acute and chronic rejection.

Objective: The aim of the present study was to assess the impact of pregnancy on the occurrence of DSA and the impact of DSA in a large population of young female LT recipients.

Methods: This single center retrospective study included all female patients who underwent a first LT between January 1990 and December 2010 and who were of childbearing age during post-LT follow-up (i.e. 18 to 40 years old).

Results: The study population consisted in 73 patients, and the mean age at LT was 20.9 years (0.6-39.9); 32 patients were transplanted during childhood. The global incidence of de novo DSA was 42.5% (31/73), after a median delay of 15.5 years (1-25) of follow-up after LT. Most de novo DSA were anti-class II alone (90.3%), and included anti-DQ for 80.6%. From the 73 patients, 33 presented at least one pregnancy after LT (45.2%) and before DSA screening. Multivariate analysis disclosed that history of pregnancy (OR = 6.37; 95%CI, 2.17-18.63, p = 0.001) and younger age at LT (OR = 0.96; 95%CI:0.92-0.99, p = 0.033) were significantly associated with de novo DSA. Among the 31 patients who had de novo DSA, the diagnosis of antibody-mediated rejection was made in 8 patients (25.8%), after a median delay of 74 months after LT; 6/8 (75.0%) had history of pregnancy. During follow-up, 3 of these 8 patients lost their liver graft and died.

Conclusion: The results of the present study suggest that close monitoring of DSA in young women with history of pregnancy should be recommended regarding the risk of DSA-mediated rejection.

Keywords: Anti-HLA antibodies; Liver transplantation; Pregnancy; Rejection.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Female
  • Follow-Up Studies
  • Graft Rejection / diagnosis*
  • Graft Rejection / mortality
  • HLA Antigens / immunology
  • Humans
  • Immunity, Humoral
  • Isoantibodies / metabolism*
  • Liver Transplantation*
  • Monitoring, Physiologic
  • Pregnancy / immunology*
  • Pregnancy Complications / diagnosis*
  • Pregnancy Complications / mortality
  • Retrospective Studies
  • Risk
  • Survival Analysis
  • Young Adult

Substances

  • HLA Antigens
  • Isoantibodies