Loh J, Hashimoto K, Kwon CHD, Fujiki M, Modaresi Esfeh J. Positive autoantibodies in living liver donors. World J Hepatol 2022; 14(9): 1757-1766 [PMID: 36185722 DOI: 10.4254/wjh.v14.i9.1757]
Corresponding Author of This Article
Jamak Modaresi Esfeh, MD, Staff Physician, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, United States. modarej@ccf.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Sep 27, 2022; 14(9): 1757-1766 Published online Sep 27, 2022. doi: 10.4254/wjh.v14.i9.1757
Positive autoantibodies in living liver donors
Joyce Loh, Koji Hashimoto, Choon Hyuck David Kwon, Masato Fujiki, Jamak Modaresi Esfeh
Joyce Loh, Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Koji Hashimoto, Choon Hyuck David Kwon, Masato Fujiki, Digestive Diseases Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Jamak Modaresi Esfeh, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, United States
Author contributions: Loh J designed, performed the research and analysis of the data and wrote the paper; Hashimoto K, Kwon CD, and Masato F helped with critical revisions of the study; Modaresi Esfeh J supervised, helped design the study, made critical revisions to the manuscript and gave final approval.
Institutional review board statement: This study was reviewed and approved by the Cleveland Clinic Foundation Institutional Review Board.
Informed consent statement: This study qualified by a Waiver of Informed Consent as determined by our hospital’s IRB as it was a retrospective study that involved no more than minimal risk to the subjects, could be reasonably carried out without the waiver, and was not a threat to the rights or welfare of the subjects.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jamak Modaresi Esfeh, MD, Staff Physician, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, United States. modarej@ccf.org
Received: May 5, 2022 Peer-review started: May 5, 2022 First decision: June 8, 2022 Revised: June 17, 2022 Accepted: September 8, 2022 Article in press: September 8, 2022 Published online: September 27, 2022 Processing time: 140 Days and 22.3 Hours
Abstract
BACKGROUND
There is a nationwide shortage of organs available for liver transplantation. Living donors help meet this growing demand. Not uncommonly, donors will have positive autoantibodies. However, it is unclear whether donor positive autoantibodies are correlated with worse outcomes following living liver donor transplantations.
AIM
To analyze the significance of positive autoantibodies in donors on post-transplant outcomes in recipients.
METHODS
We performed a retrospective review of living liver donors who had undergone liver transplantation between January 1, 2012 and August 31, 2021. Demographic characteristics and pre-transplant data including antinuclear antibodies (ANA) and anti-smooth muscle antibody titers were collected in donors. Outcomes of interest were post-transplantation complications including mortality, biliary strictures, biliary leaks, infection, and rejection. Pediatric recipients and donors without measured pre-transplant autoantibody serologies were excluded from this study.
RESULTS
172 living donor liver transplantations were performed during the study period, of which 115 patients met inclusion criteria. 37 (32%) living donors were autoantibody-positive with a median ANA titer of 1:160 (range 1:80 to 1:1280) and median anti-SMA titer of 1:40 (range 1:20 to 1:160). There were no significant differences in baseline demographics between the autoantibody positive and negative donors. Post-transplantation rates of death (P value = 1), infections (P value = 0.66), and overall rates of complications (P value = 0.52) were similar between the autoantibody positive and negative groups. Higher incidences of anastomotic strictures and rejection were observed in the autoantibody positive group; however, these differences were not statistically significant (P value = 0.07 and P value = 0.30 respectively).
CONCLUSION
Isolated pre-transplant autoantibody positivity is not correlated to worse post-transplant outcomes in living liver donor transplants.
Core Tip: This was a retrospective study designed to analyze the significance of positive autoantibodies in donors on post-transplant outcomes in recipients in living donor liver transplantations. Post-transplantation rates of complications including mortality (P value = 1), infections (P value = 0.66), anastomotic strictures (P value = 0.07), and rejection (P value = 0.30) were found not to be statistically significant between the autoantibody positive and negative groups. These results suggest that isolated pre-transplant autoantibody positivity is not correlated to worse post-transplant outcomes in living liver donor transplants and should not preclude donors from donating.
