Antibody-mediated Rejection Clinical Trial
Official title:
Role of Donor Specific Antibodies, Other Anti-human Leucocyte Antibodies and Autoantibodies in the Outcome of Liver Retransplantation
Despite reports that associate donor specific antibody (DSA) with rejection after liver transplantation, grafts are still allocated according to blood group (ABO) but not human leukocyte antigen (HLA) compatibility, possibly due to the absence of an easily discernible clinical association between adverse recipient outcome and DSA. Re-transplantation provides a test environment where the presence of preformed DSA or other antibodies is prevalent and events (graft loss) more common so that the effect of these antibodies on outcome should be apparent. This is an observational study of routine clinical care to determine these effects on our own patients. The goal is to perfect donor-recipient matching to attain the best outcome. In addition, we may develop hypotheses and potential treatments that would be tested in further clinical trials
Despite reports that associate donor specific antibody (DSA) with rejection after liver
transplantation, grafts are still allocated according to blood group (ABO) but not human
leukocyte antigen (HLA) compatibility, possibly due to the absence of an easily discernible
clinical association between adverse recipient outcome and DSA. Re-transplantation provides a
test environment where the presence of preformed DSA or other antibodies is prevalent and
events (graft loss) more common so that the effect of these antibodies on outcome should be
apparent. This is an observational study of routine clinical care to determine these effects
on our own patients.
In phase 1, we will examine the effect of antibodies specifically directed against the second
donor in liver retransplantation. Other factors known to effect the outcome will be checked
to allow for risk adjustment.
In phase 2, we will examine the role played by specific auto-antibodies such as angiotensin
II receptor type 1 antibodies and endothelin-1 type A receptor antibodies on the outcome of
liver retransplantation.
The goal of these observational study is to perfect donor-recipient matching to attain the
best outcome. In addition, we may develop hypotheses and potential treatments that would be
tested in further clinical trials.
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