Evidence map›Paper›PMID 31748871›Full record

ArticleLangenbeck's archives of surgery2019

Exploring pre-surgery donor-specific antibodies in the context of organ shortage in liver transplant.

Savio G Barreto, Mark E Brooke-Smith, Eu Ling Neo, Paul Dolan, Richard Leibbrandt, Tim Emery, Robert Carroll, Alan Wigg, John W Chen

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Article in Langenbeck's archives of surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Savio G BarretoHepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.ORCID http://orcid.org/0000-0002-4999-5657
Mark E Brooke-SmithHepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.
Eu Ling NeoHepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.
Paul DolanSouth Australia Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.
Richard LeibbrandtCollege of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Tim EmerySouth Australian Transplantation & Immunogenetics Service, Australian Red Cross Blood Service, Adelaide, South Australia, Australia.
Robert CarrollDepartment of Renal Medicine, The Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Alan WiggCollege of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
John W ChenHepatobiliary Unit, Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia. john.chen@flinders.edu.au.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is a growing disparity between the number of liver transplant (LT) candidates and availability of suitable liver allografts. Antibody-mediated rejection (AMR), secondary to positive donor-specific antibodies (DSA), remains a concern in liver transplantation. This study aimed to correlate expression of DSA on pre-transplant screening and outcomes of LT, specifically development of AMR in liver allografts and liver function profile in the post-operative period.

methodsData of consecutive patients undergoing orthotopic LT (OLT) at the South Australian Liver Transplant Unit was analysed. All patients underwent DSA testing pre-transplant.

resultsWithin a cohort of 96 patients, over a post-OLT median follow-up of 849 days, only 2 patients (2%) developed AMR. While both patients had a positive DSA test preoperatively, overall DSA positivity was noted in 31% patients, with a specificity for prediction of AMR of 0.708. No significant association was noted between AMR (p = 0.092), T cell-mediated rejection/TCMR (p = 0.797) or late hepatic artery thrombosis/LHAT (p = 0.521). There was no significant interaction effect between DSA positivity and serum bilirubin or transaminases over a period of 100 days.

conclusionAMR following LT is uncommon. A positive DSA pre-transplant does not imply a definite risk of AMR. Also, there does not exist a significant interaction in time between DSA expression and serum bilirubin or transaminase levels. Until there emerges evidence to the contrary, it appears reasonable to consider DSA-positive donors within the broad context of marginal donors in the context of a worldwide shortage of LT donor allografts.

Indexed as

Antibody SpecificityCohort StudiesFemaleFollow-Up StudiesGraft RejectionHumansImmunosuppressive AgentsLiverLiver Function TestsLiver TransplantationMaleMiddle AgedRetrospective StudiesSouth AustraliaTissue DonorsT-LymphocytesImmunosuppressive AgentsOutcomesRejectionThrombosis

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.