Plenary Sessions

TL;DR: The study found that recipients of LDLT are more likely to have bile leak, biliary stricture, HAT and bacteremia while recipients of DDLT are more likely to have ascites, intra-abdominal bleeding, cardiac complications and recurrent cirrhosis.

Abstract: 572 Post-Transplant Complications in Recipients of Deceased and Living Donor Liver Transplant. B. Samstein,1 A. Smith,2,8 C. Freise,3 M. Zimmerman,4 T. Baker,5 K. Olthoff,6 R. Fisher,7 R. Merion.2,8 1Columbia U; 2Arbor Research Collaborative for Health; 3U of California at San Francisco; 4U of Colorado; 5Northwestern U; 6U of Pennsylvania; 7Virginia Commonwealth U; 8U of Michigan. Purpose: To study long-term complications in recipients of deceased donor liver transplant (DDLT) and living donor liver transplant (LDLT) in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Methods: We analyzed 471 DDLT and 565 LDLT from 1998 to 2010 followed up to 10 years for 39 categories of complications graded by Clavien-Dindo classifi cation. Kaplan-Meier was used to estimate probability of complication and resolution over time, and predictors of complications were tested in Cox models. Results: Recipients of LDLT were more likely to be white, have cholestatic liver disease. DDLT recipients were more likely to have HCC, be in the ICU, on a ventilator, or have ascites. 85% and 47% of LDLT and DDLT recipients had a physiologic MELD less than 21 at the time of the transplant. Median follow-up for DDLT and LDLT was 3.12 and 3.52 years, respectively. Complications more probable in LDLT included bile leak, biliary stricture, HAT and bacteremia. In DDLT, ascites, intra-abdominal bleeding, cardiac complications and recurrent cirrhosis were more probable. At least one complication occurred in 70% and 73% of DDLT and LDLT, respectively. A higher probability of grade 3 or 4 complications was observed in LDLT recipients (28 % vs. 20% at 8 years, p=0.03). We found that risk factors for Grade 4 complications were DCD, dialysis at transplant, ascites, and duration of operation, but no signifi cant difference between DDLT and LDLT (HR=0.89, p=0.60). Development of chronic kidney disease was less likely in LDLT recipients (HR 0.41, p=0.02). 95% of complications resolved in 5 years, with 86% of complications resolving in 12 months and no statistical difference between DDLT and LDLT. Biliary strictures, hernia, vascular and psychological complications had the lowest probability of resolution within 12 months. Conclusions: Biliary and vascular complications remain a challenge in LDLT while renal impairment, cardiac complications and recurrent cirrhosis are more probable in DDLT. Abstract# 573 Detection of C3d-Binding Donor-Specific Anti-HLA Antibodies at Diagnosis of Humoral Rejection Predicts Renal Graft Loss. A. Sicard,1,2,3 S. Ducreux,4 M. Rabeyrin,5 B. McGregor,5 L. Badet,3,6 J. Scoazec,3,5 V. Fremeau-Bacchi,7,8 E. Morelon,1,2,3 V. Dubois,4 O. Thaunat.1,2,3 1Kidney Transplantation, Hospices Civiles de Lyon, Lyon, France; 2U1111, INSERM, Lyon, France; 3Lyon 1 University, Lyon, France; 4Etablissement Francais du Sang, Lyon, France; 5Anatomopathology, Hospices Civiles de Lyon, Lyon, France; 6Urology and Transplantation, Hospices Civiles de Lyon, Lyon, France; 7UMRS 872, INSERM, Paris, France; 8Immunobiology, Hopital Europeen Georges Pompidou, Paris, France. A. Although antibody-mediated rejection (AMR) is a major cause for kidney-graft loss, the assessment of individual risk at diagnosis is impeded by the lack of reliable prognosis assay. B. We tested whether the capacity of donor specifi c anti-HLA antibodies (DSA) to bind C3d, a complement component, could allow for risk stratifi cation at the time of AMR diagnosis. 938 kidney transplant recipients were screened and 69 fulfi lled the diagnosis criteria for AMR. The biopsies were reviewed and the sera banked at the time of the biopsy were screened for anti-HLA antibodies and their C3d-binding capacity using fl ow beads assays. C. Patients with (n=40) or without (n=29) C3d+DSA had similar characteristics at time of transplantation. At AMR, patients with C3d+DSA had comparable histological lesions but worst eGFR and higher titers of DSA. Groups received the same treatments. In contrast with C4d graft deposition, C3d+DSA were associated with a higher risk of graft loss (p<0.001). Multivariate analysis identifi ed only two independent predictors for graft loss at diagnosis of AMR: eGFR<30 ml/min [HR=3.56 (1.46-8.70); p=0.005] and the