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.

中文翻译：

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肝移植后的妊娠和供体特异性HLA抗体介导的排斥反应：“ Liaisonsangereuses”吗？

背景

抗HLA抗体发展的危险因素包括输血，器官移植和怀孕。在所有类型的实体器官移植中都研究了由供体特异性抗HLA抗体（DSA）介导的体液排斥，并且一些研究表明肝后移植（LT）DSA可能在急性和慢性排斥中起作用。

目的

本研究的目的是评估妊娠对DSA发生的影响以及DSA在大量年轻女性LT接受者中的影响。

方法

这项单中心回顾性研究纳入了所有在1990年1月至2010年12月之间接受首次LT且在LT随访后达到育龄（即18至40岁）的女性患者。

结果

研究人群包括73例患者，LT的平均年龄为20.9岁（0.6-39.9）。儿童期有32例患者被移植。在进行LT后中位随访延迟15.5年（1-25）后，从头DSA的全球发生率为42.5％（31/73）。多数从头DSA均为抗II类药物（90.3％），包括抗DQ药物占80.6％。在73例患者中，有33例在LT后（45.2％）和DSA筛查之前至少有一次妊娠。多因素分析显示，妊娠史（OR = 6.37； 95％CI，2.17-18.16，p = 0.001）和更年轻的LT（OR = 0.96； 95％CI：0.92-0.99，p = 0.033）与以下因素显着相关从头开始DSA。在31例从头开始的患者中DSA中，LT的中位延迟为74个月，诊断为抗体介导的排斥反应的患者为8例（25.8％）。6/8（75.0％）有怀孕史。在随访期间，这8例患者中有3例失去了肝脏移植并死亡。

结论

本研究的结果表明，应建议对有妊娠史的年轻女性进行DSA的密切监测，以了解DSA介导的排斥反应的风险。