Incidence of anti-HLA donor specific antibodies in liver-transplant patients given mTOR inhibitors without calcineurin inhibitors

After liver transplantation (LT), immunosuppression with mammalian target-of-rapamycin (mTOR) inhibitors without calcineurin inhibitors (CNIs) is used to preserve kidney function [1], and because of its anti-neoplastic effect, particularly for patients who have a history of hepatocellular carcinoma [2]. However, in kidney-transplant patients, this immunosuppressive strategy has been associated with an increased risk of developing donor-specific antibodies (DSAs) [3]. After a LT, although the impact of the occurrence of de novo DSAs on short- and long-term outcomes is still controversial [4], de novo DSAs are associated with an increased risk of antibody-mediated rejection [5], chronic rejection [6–8], and anastomotic biliary stricture [9].