Zhang LY, Ling YH, Zhang HQ, Tang CW, Mo QL. Impact of donor-specific antibodies on immune rejection rates in liver transplantation: A systematic review and meta-analysis. World J Gastrointest Surg 2026; 18(5): 117518 [DOI: 10.4240/wjgs.v18.i5.117518]
Corresponding Author of This Article
Cheng-Wu Tang, PhD, Department of General Surgery, Huzhou Key Laboratory of Translational Medicine, Huzhou First People’s Hospital, The First Affiliated Hospital of Huzhou University, No. 158 Guangchanghou Road, Wuxing District, Huzhou 313000, Zhejiang Province, China. dr_tcw@163.com
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Gastroenterology & Hepatology
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research-article
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Zhang LY, Ling YH, Zhang HQ, Tang CW, Mo QL. Impact of donor-specific antibodies on immune rejection rates in liver transplantation: A systematic review and meta-analysis. World J Gastrointest Surg 2026; 18(5): 117518 [DOI: 10.4240/wjgs.v18.i5.117518]
World J Gastrointest Surg. May 27, 2026; 18(5): 117518 Published online May 27, 2026. doi: 10.4240/wjgs.v18.i5.117518
Impact of donor-specific antibodies on immune rejection rates in liver transplantation: A systematic review and meta-analysis
Lu-Yi Zhang, Yu-Hang Ling, Hong-Quan Zhang, Cheng-Wu Tang, Qin-Liang Mo
Lu-Yi Zhang, Yu-Hang Ling, Hong-Quan Zhang, Cheng-Wu Tang, Qin-Liang Mo, Department of General Surgery, Huzhou Key Laboratory of Translational Medicine, Huzhou First People’s Hospital, The First Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
Co-corresponding authors: Cheng-Wu Tang and Qin-Liang Mo.
Author contributions: Zhang LY performed data extraction, statistical analyses and data interpretation; Ling YH drafted the initial manuscript; Ling YH and Zhang HQ confirmed the authenticity of all the raw data; Zhang HQ, Tang CW, and Mo QL revised the manuscript for important intellectual content; Tang CW and Mo QL contributed to the conceptualization, design of the study, and they contributed equally to this work and are co-corresponding authors. All authors read and approved the final version of the manuscript.
Supported by Postgraduate Research and Innovation Project of Huzhou University, No. 2025KYCX104.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Cheng-Wu Tang, PhD, Department of General Surgery, Huzhou Key Laboratory of Translational Medicine, Huzhou First People’s Hospital, The First Affiliated Hospital of Huzhou University, No. 158 Guangchanghou Road, Wuxing District, Huzhou 313000, Zhejiang Province, China. dr_tcw@163.com
Received: January 16, 2026 Revised: February 12, 2026 Accepted: March 19, 2026 Published online: May 27, 2026 Processing time: 131 Days and 5.3 Hours
Abstract
BACKGROUND
Liver transplantation is the definitive treatment for end-stage liver disease. While the liver is considered relatively immunotolerant, the clinical impact of donor-specific antibodies (DSAs) remains controversial. Some evidence suggests DSAs contribute to antibody-mediated rejection and graft injury, whereas other data indicate minimal effects on outcomes. This uncertainty complicates post-transplant management and risk assessment. We hypothesized that the presence of DSAs, particularly those with high mean fluorescence intensity, is significantly associated with increased rates of immune rejection in liver transplant recipients.
AIM
To investigate the effect of DSAs on immune rejection rates in patients receiving liver transplants.
METHODS
A systematic review and meta-analysis were conducted using PubMed, Excerpta Medica, and Cochrane databases (January 2010 to March 2025). Out of 1550 records, 10 studies meeting inclusion criteria were selected. Data on demographics, mean fluorescence intensity, and rejection outcomes were extracted. Statistical analysis utilized pooled odds ratios with 95% confidence intervals, sensitivity analysis to assess study variability, and meta-regression to evaluate the impact of mean fluorescence intensity levels, patient age, and sex on rejection risk.
RESULTS
The pooled analysis showed no significant association between the presence of donor-specific antibodies and antibody-mediated rejection (odds ratio = 0.528; 95% confidence interval: 0.227-1.228). However, meta-regression demonstrated that increased mean fluorescence intensity levels significantly correlated with higher rejection risk. Sensitivity analysis indicated that excluding one specific study altered the statistical significance of the primary outcome, highlighting heterogeneity. An inverse association was observed between Model for End-Stage Liver Disease scores and rejection risk. Factors such as DSA class ratio, patient age, and sex had minimal impact on outcomes.
CONCLUSION
While donor-specific antibodies alone do not consistently predict rejection, high mean fluorescence intensity levels serve as indicators of adverse outcomes. Standardized detection and personalized immunosuppression may optimize graft survival.
Core Tip: This meta-analysis evaluates the impact of donor-specific antibodies (DSAs) on immune rejection following liver transplantation. While the presence of DSAs alone may not consistently predict rejection, quantitative measures - specifically high mean fluorescence intensity levels - are significantly correlated with increased rejection risk. These findings suggest that standardized, quantitative DSA monitoring, rather than simple qualitative detection, is essential for guiding personalized immunosuppressive protocols and optimizing long-term graft survival.
