Swiss Transplant Cohort Study: Impact of preformed DSA on liver transplantation outcomes

Results from a multicenter, retrospective analysis of the Swiss Transplant Cohort Study (STCS; NCT01204944), evaluating the impact of preformed donor-specific antibodies (pf-DSA) on outcomes following liver transplantation, were published in Liver Transplantation by Vionnet et al. The analysis included 321 liver transplant procedures in 306 patients. pf-DSA positivity was defined as mean fluorescence intensity (MFI) ≥1,000. Outcomes included 1-year patient and allograft survival, rejection episodes, and biliary, vascular, and infectious complications. 

Key data: pf-DSA were detected in 28.7% of liver transplant procedures. One-year patient and graft survival were similar in pf-DSA-positive and pf-DSA-negative patients (92.4% vs 94.3%; p = 0.55 and 89.1% vs 90.4%; p = 0.49, respectively), while the incidence of graft failure was higher in pf-DSA-positive patients with cumulative MFI (cMFI) ≥5,000 vs <5,000 and ≥10,000 vs <10,000 (both p = 0.02). One-year biopsy-proven rejection was more frequent in patients with vs without pf-DSA (30.4% vs 17.5%; p = 0.01). In multivariate analysis, pf-DSA were independently associated with biliary complications (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.17–4.37; p = 0.02) and anastomotic biliary complications (HR, 2.07; 95% CI, 1.18–3.61; p = 0.01) but not vascular or infectious complications. 

Key learning: pf-DSA may help identify liver transplant recipients at greater risk of early rejection and biliary complications, supporting pre-transplant immunological risk assessment and tailored post-transplant monitoring in this setting.