The Presence of Non‐HLA Antibody With DSA Is Associated With Moderate to Severe T Cell‐Mediated Rejection in Liver Transplant Recipients

BACKGROUND: Antibodies to donor HLA (DSA) and non-HLA antigens are associated with detrimental outcomes in kidney, heart, and lung transplants. Such data are scarce in liver transplants (LTx). We aim to study the roles of DSA and non-HLA antibodies in T-cell-mediated rejection (TCMR) of LTx. METHODS: Allograft biopsies (n = 103) from adult LTx recipients were studied. Biopsy-paired serums were retrospectively tested for anti-angiotensin II type 1 receptor (AT1R) and the Luminex panel of 60 non-HLA Antibodies. RESULTS: TCMR was detected in 59 of 103 (57.3%) biopsies. Twenty-six biopsies were categorized as moderate-severe (MS-TCMR), 77 as negative-mild (NM-TCMR). DSA was positive in 95/103 (92.2%) cases and wasn't associated with MS-TCMR. Anti-AT1R antibodies were elevated in serum paired with MS-TCMR vs. NM-TCMR (18.8[15.2-40.0] vs. 13.0[10.0-21.5] U/ml, p < 0.01). Positive anti-AT1R antibodies were associated with a higher incidence of MS-TCMR (HR = 12.4[1.5-101.6], p = 0.02). A panel of 18 non-HLA Abs was significantly associated with MS-TCMR. The number of panel-18 non-HLA antibodies was higher with MS-TCMR vs. NM-TCMR (3[2-5] vs. 1[0-1], p < 0.001). The incidence of MS-TCMR was higher in cases with panel-18 non-HLA antibodies ≥3 vs.