Immunologic benefits of maternal living donor allografts in pediatric liver transplantation: fewer rejection episodes and no evidence of de novo allosensitization
Arianna Barbetta
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
Search for more papers by this authorGlenda Meeberg
Alberta Transplant Institute, Edmonton, Alberta, Canada
Search for more papers by this authorBrittany Rocque
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
Search for more papers by this authorSarah Barhouma
University of Southern California, Los Angeles, California, USA
Search for more papers by this authorCarly Weaver
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorSusan Gilmour
Alberta Transplant Institute, Edmonton, Alberta, Canada
Search for more papers by this authorFarah Faytrouni
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorOrlee Guttman
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorShannon Zielsdorf
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorKambiz Etesami
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorYong Kwon
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorGeorge Yanni
University of Southern California, Los Angeles, California, USA
Department of Pediatrics, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorPatricia Campbell
Alberta Transplant Institute, Edmonton, Alberta, Canada
Departemtent of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorJames Shapiro
Alberta Transplant Institute, Edmonton, Alberta, Canada
Search for more papers by this authorCorresponding Author
Juliet Emamaullee
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Correspondence
Juliet Emamaullee, Department of Surgery, 1510 San Pablo St. Suite 412, Los Angeles, CA 90033, USA.
Email: [email protected]
Search for more papers by this authorArianna Barbetta
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
Search for more papers by this authorGlenda Meeberg
Alberta Transplant Institute, Edmonton, Alberta, Canada
Search for more papers by this authorBrittany Rocque
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
Search for more papers by this authorSarah Barhouma
University of Southern California, Los Angeles, California, USA
Search for more papers by this authorCarly Weaver
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorSusan Gilmour
Alberta Transplant Institute, Edmonton, Alberta, Canada
Search for more papers by this authorFarah Faytrouni
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorOrlee Guttman
Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
Search for more papers by this authorShannon Zielsdorf
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorKambiz Etesami
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorYong Kwon
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorGeorge Yanni
University of Southern California, Los Angeles, California, USA
Department of Pediatrics, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Search for more papers by this authorPatricia Campbell
Alberta Transplant Institute, Edmonton, Alberta, Canada
Departemtent of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorJames Shapiro
Alberta Transplant Institute, Edmonton, Alberta, Canada
Search for more papers by this authorCorresponding Author
Juliet Emamaullee
Department of Surgery, Division of Abdominal Organ Transplant, University of Southern California, Los Angeles, California, USA
University of Southern California, Los Angeles, California, USA
Division of Hepatobiliary and Abdominal Organ Transplantation Surgery, Children’s Hospital-Los Angeles, Los Angeles, California, USA
Correspondence
Juliet Emamaullee, Department of Surgery, 1510 San Pablo St. Suite 412, Los Angeles, CA 90033, USA.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Pediatric liver transplant (LT) recipients of maternal living liver donor (LLD) grafts have been reported to experience fewer rejection episodes. However, it is unclear whether this benefit translates to reduction in developing donor-specific antibody (DSA) among maternal-LLD recipients. The aim of this study was to compare immunologic outcomes among maternal-LLD, non-maternal-LLD, and deceased donor liver transplant (DDLT) recipients.
Methods
Children (≤18 years) who underwent LT between 1/1998 and 12/2019 at two high-volume LT centers in North America were evaluated. Patients were divided into three groups by type of graft received (maternal-LLD, non-maternal LLD, and DDLT). Clinical variables and outcomes were compared according to each graft type.
Results
A total of 450 pediatric primary LT were analyzed: 275 (61.1%) DDLT, 73 (16.2%) maternal-LLD, and 102 (22.6%) non-maternal-LLD. Children receiving LLD grafts were less likely to develop rejection when compared to the DDLT group (DDLT 46.9% vs. maternal-LLD 31.5% vs. non-maternal-LLD 28.4%, p = 0.001). There was no difference in rejection rates between maternal and non-maternal-LLD recipients. A higher percentage of maternal-LLD recipients were on immunosuppression monotherapy compared to non-maternal-LLD and DDLT recipients (6.7% vs. 1.2 vs. 2.4%, respectively). A subgroup of 68 patients were tested for DSA post-LT. Maternal-LLD recipients were less likely to develop de novo DSA (maternal-LLD 11.8% vs. non-maternal-LLD 19.3% vs. DDLT 43%, p = 0.018). None of the maternal-LLD recipients developed antibody-mediated rejection.
Conclusions
These data support the concept of immunologic benefit of maternal-LLD in pediatric LT, with lower rates of rejection and allosensitization post-LT when compared to DDLT recipients.
Open Research
DATA AVAILABILITY STATEMENT
Data may be made available upon request, subject to USC institutional review board policies.
Supporting Information
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