Impact of donor-specific antibodies on immune rejection rates in liver transplantation: A systematic review and meta-analysis

Table 1 Summary of studies on donor-specific antibodies in liver transplantation

Ref.	Study characteristics	Number of patients	Detection method	MFI threshold	Immunosuppression	Outcomes
Del Bello et al[26], 2015	Incidence of de novo DSAs	152	Luminex	> 1000	CNI, MMF and steroids	In total, 14% of patients developed DSAs. Among these DSA-positive patients, 43% (equivalent to 6% of the total cohort) developed AMR
Del Bello et al[27], 2020	Preformed DSAs and outcomes	1788	Luminex (One Lambda, Immucor)	1000-5000	Tac, CNI, mycophenolic acid, mTOR inhibitors and steroids	High MFI DSAs associated with rejection
Kaneku et al[28], 2013	Role of de novo DSAs	749	Luminex	> 5000	CyA/Tac/SRL/MMF	Graft loss was predicted in 8.1% of all patients who developed de novo DSAs
Iacob et al[29], 2015	Humoral response and graft failure	174	Luminex	> 5000 (class II)	CNI-based	In total, 19.5% of patients with DSAs who had class II antibodies and C4d positivity experienced graft failure
O'Leary et al[31], 2014	DSAs and fibrosis in HCV	507	Luminex	> 5000	CNI, MMF and SRL	The presence of DSAs was associated with an increased risk of fibrosis and mortality
San Segundo et al[32], 2016	Long-term de novo DSAs	28	Luminex and C1q	> 3500	CNI-based	DQ DSAs and fibrosis
Song et al[33], 2015	DSAs in LDLT	219	Enzyme-linked immunosorbent assay	> 3500	Tac and basiliximab	Among DSA-positive patients, 14.6% had multiple DSAs, which was associate with a poor outcome
Taner et al[34], 2012	DSA course of 1 year	90	Luminex	> 2000	Triple therapy	Preformed DSAs were detected in 22.2% of patients, but they had a limited impact on graft outcomes
Vandevoorde et al[35], 2018	DSA prevalence and risk	297	Immucor LSA	≥ 1500	CNI, MMF and steroids	Preformed DSAs were present in 4.7% of patients and showed a limited clinical impact
Ogawa et al[30], 2023	DSAs in LDLT with desensitization	37	FlowPRA and Luminex	≥ 1000	Tac, MMF and Rituximab	After 1-year, 100% of patients survived

DSA: Donor-specific antibody; HCV: Hepatitis C virus; LDLT: Living donor liver transplantation; MFI: Mean fluorescence intensity; CNI: Calcineurin inhibitor; MMF: Mycophenolate mofetil; Tac: Tacrolimus; mTOR: Mammalian target of rapamycin; CyA: Cyclosporine A; SRL: Sirolimus; AMR: Antibody-mediated rejection; DQ DSAs: Donor-specific antibodies targeting human leukocyte antigen-DQ antigens.

Table 2 Newcastle-Ottawa scale quality assessment of key studies on donor-specific antibodies in adult liver transplantation

Ref.	Selection (0-4)	Comparability (0-2)	Outcome (0-3)	Total (0-9)
Del Bello et al[26], 2015	4	1	3	8
Del Bello et al[27], 2020	4	2	3	9
Kaneku et al[28], 2013	4	2	3	9
Iacob et al[29], 2015	4	1	3	8
Ogawa et al[30], 2023	4	2	3	9
O'Leary et al[31], 2014	4	1	3	8
San Segundo et al[32], 2016	4	1	3	8
Song et al[33], 2015	3	0	3	6
Taner et al[34], 2012	4	0	3	7
Vandevoorde et al[35], 2018	4	0	3	7