Donor-specific antibodies, immunoglobulin-free light chains, and BAFF levels in relation to risk of late-onset PTLD in liver recipients Journal Article
| Authors: | Engels, E. A.; Jennings, L. W.; Everly, M. J.; Landgren, O.; Murata, K.; Yanik, E. L.; Pfeiffer, R. M.; Onaca, N.; Klintmalm, G. B. |
| Article Title: | Donor-specific antibodies, immunoglobulin-free light chains, and BAFF levels in relation to risk of late-onset PTLD in liver recipients |
| Abstract: | Background. Posttransplant lymphoproliferative disorder (PTLD) is a neoplastic complication of transplantation, with early cases largely due to immunosuppression and primary Epstein-Barr virus infection. Etiology may differ for later-onset cases, but the contributions of immunosuppression, immune reactivity to the donor organ, and chronic B cell activation are uncertain. Methods. We conducted a case-control study of late-onset PTLD (diagnosed >1 year posttransplant) in a cohort of liver recipients. We assessed serum samples (obtained >6 months before diagnosis in cases) from N = 60 cases and N = 166 matched controls for donor-specific antibodies (DSAs, evaluable for N = 221 subjects), immunoglobulin kappa and lambda free light chains (FLCs, N = 137), and B cell activating factor (BAFF, N = 226). Conditional or unconditional logistic regression was used to calculate adjusted odds ratios (aORs). Results. Circulating DSAs were less common in PTLD cases than controls (18% vs 30%), although this difference was borderline significant (aOR, 0.51; 95% confidence interval [CI], 0.24-1.10; P = 0.09). Donor-specific antibodies against class II HLA antigens predominated and likewise showed a borderline inverse association with PTLD (aOR, 0.58; 95% CI, 0.27-1.24). The FLC levels were less frequently abnormal in cases than controls, but measurements were available for only a subset and confidence intervals were wide (elevated kappa: aOR, 0.57; 95% CI, 0.15-2.12; P = 0.40; elevated lambda: aOR, 0.68; 95% CI, 0.30-1.50; P = 0.34). B cell–activating factor levels were not associated with PTLD. Conclusions. Our results suggest that circulating DSAs are associated with decreased risk of late-onset PTLD. Because DSAs may develop in the setting of underimmunosuppression, the inverse association with DSAs supports a role for immunosuppression in the etiology of late-onset PTLD. Copyright © 2018 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
| Journal Title: | Transplantation Direct |
| Volume: | 4 |
| Issue: | 6 |
| ISSN: | 2373-8731 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2018-06-01 |
| Start Page: | e353 |
| Language: | English |
| DOI: | 10.1097/txd.0000000000000792 |
| PROVIDER: | scopus |
| PMCID: | PMC6089512 |
| PUBMED: | 30123826 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 May 2019 -- Source: Scopus |
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