Clinical research of incomplete immune tolerance to donor specific blood group antigen in pediatric ABO incompatible living donor liver transplantation recipients
10.3760/cma.j.cn421203-20211125-00294
- VernacularTitle:儿童ABO血型不相容活体肝移植术后供者血型抗原不完全免疫耐受状态的研究
- Author:
Wei QU
1
;
Zhijun ZHU
;
Liying SUN
;
Lin WEI
;
Zhigui ZENG
;
Ying LIU
;
Jun WANG
;
Yule TAN
Author Information
1. 首都医科大学附属北京友谊医院普通外科 首都医科大学儿童肝脏移植临床诊疗与研究中心 国家消化系统疾病临床研究中心，北京 100050
- Keywords:
ABO incompatible;
ABO-incompatible donated liver;
Incomplete immune tolerance
- From:
Chinese Journal of Organ Transplantation
2022;43(4):219-223
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the potential immune mechanism of pediatric ABOi-LDLT presenting low humoral immune response to donor specific blood group antigen.Methods:From June 2013 to December 2020, clinical data were retrospectively reviewed for 29 patients of long-term surviving pediatric ABOi-LDLT.There were A to O ABOi-LDLT( n=10)and B to O ABOi-LDLT( n=19). Graft types included left lateral lobe( n=26)and left hemi-liver( n=3). The median age of liver transplantation was 10 months, the median weight 8.0 kg and the median follow-up time 41.9 months.The titers of donor specific blood group antibodies and non-donor specific blood group antibodies(IgG, IgM)were continuously monitored before transplantation and at 1, 3, 6, 12, 24, 36 months post-transplantation.Protocol or event-based liver biopsy was performed to determine whether or not there was antibody-mediated rejection. Results:The titer of donor specific blood group antibody in recipients was significantly lower than that of non-donor specific blood group antibody( P<0.001). Among 18 protocol liver pathological biopsies, two cases were C4d positive for vascular endothelium.Five abnormal event-based liver biopsies were completed and one was C4d positive in bile duct endothelium.No pathological sign of typical blood group antibody mediated antigen-antibody complex mediated cascade immune reaction was detected in liver pathological biopsy.Typical pathological signs of blood group antibody mediated rejection were absent in protocol liver biopsy. Conclusions:Donor specific blood group antibody is expressed at a low level in pediatric ABOi-LDLT recipients.It presents as incomplete immune tolerance to donor specific blood group antigen.
