Preformed donor-specific antibodies are associated with acute rejection and biliary complications after liver transplantation: A Swiss Transplant Cohort Study analysis
Year: 2026
Type: article
Abstract: The impact of preformed donor-specific antibodies (DSA) in liver transplantation (LT) remains controversial despite evidence linking their presence to an increased risk of early allograft damage, as well as antibody- and T-cell-mediated rejection. In this nationwide analysis, preformed DSA were assessed using single-antigen bead assays [positive if mean fluorescence intensity (MFI) ≥1000]. This study included all LT recipients enrolled in the Swiss Transplant Cohort Study (STCS) who underwent LT between 2014 and 2016. One-year post-LT outcomes, including cumulative allograft and patient survival, as well as the incidence of biliary, vascular, and infectious complications, were compared between DSA-positive (DSA+) and DSA-negative (DSA-) individuals. Among 321 LT performed in 306 patients, preformed DSA were detected in 92 (28.7%) and more frequently observed in patients with a history of prior transplantation ( p =0.008) or autoimmune liver disease ( p =0.036). Class I and II DSA were present in 48.9% and 71.1% of DSA+ cases, with concomitant class I and II DSA in 20.7%. The median (IQR) cumulative MFI (cMFI) of the preformed DSA was 3768 (1875-10,537), and 52.2% of DSA+ patients harbored multiple DSA. While overall patient survival did not differ between DSA+ and DSA- individuals, DSA+ patients with cMFI ≥5000 exhibited a higher incidence of allograft failure and biopsy-proven rejection. Multivariate analysis revealed that the presence of preformed DSA was independently associated with biliary complications (HR 2.26, 95% CI 1.17-4.37, p =0.02) but not with vascular or infectious complications. In summary, preformed DSA were associated with biliary complications, increased rejection, and reduced allograft survival. These findings suggest pre-transplant immunological risk assessment and the need for tailored immunosuppressive strategies in LT.
Source: Liver Transplantation
Authors: Julien Vionnet, Sylvie Ferrari-Lacraz, Linard David Hoessly, Antonio Mancarella, Yannick D. Müller, Stefan Schaub, Jakob Nilsson, Urs Wirthmüller, Susanne Stampf, Michael Koller, Nicolas J. Mueller, Myriam Amrari, Oriol Manuel, Dela Golshayan, Montserrat Fraga, Darius Moradpour, Nicolas Goossens, Giulia Magini, Philippe Compagnon, Valérie McLin, Nathalie Rock, Barbara Wildhaber, Andreas E. Kremer, Jose Oberholzer, Richard Xavier Sousa Da Silva, Pascale Tinguely, Loreta Kavaliukaite, Annalisa Berzigotti, Vanessa Banz, Christine Bernsmeier, Philipp Dutkowski, David Semela, Matthias Niemann, Giuseppe Pantaleo, Manuel Pascual, Jean Villard, and the Swiss Transplant Cohort Study (STCS)
Institutions: Centre Hospitalier Universitaire Vaudois, University of Lausanne, University of Geneva, University Hospital of Geneva, University Hospital of Basel, University Hospital Zurich, University Hospital of Bern, University of Zurich, University of Bern, University of Basel, Kantonsspital St. Gallen
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,150
OpenAlex ID: W7141736364
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