Table 1.

Summary of recent studies of de novo DSA on clinical outcomes ABO-compatible liver transplantation.

Reference	Study design	Sample size	Prevalence of de novo DSA	Study findings
Kaneku et al. (2013) [13]	Retrospective	749 adult	8.1% at 1 year	(i) Presence of DSA associated with inferior patient and graft survival (ii) Almost all de novo DSA were against HLA class II antigens (majority DQ) (iii) Risk of de novo DSA formation increased by low calcineurin inhibitor levels and the use of cyclosporine (versus tacrolimus)
Grabhorn et al. (2015) [17]	Retrospective	43 pediatric	33% in stable recipients; 68% in chronic rejectors	(i) Higher rate of de novo DSA among pediatric LT recipients with chronic rejection (ii) Antibodies predominantly against HLA class II antigens
O'Leary et al. (2015) [15]	Retrospective	749 adult	8% at 1 year	(i) IgG3 subclass DSA-positive patients at highest risk for death (ii) IgG3-negative, DSA-positive patients still had inferior outcomes compared to DSA-negative patients
Wozniak et al. (2015) [16]	Cross-sectional	50 pediatric	54%	(i) Younger age associated with presence of DSA (ii) Nontolerant patients more likely to have DQ DSA (61%) compared with stable (20%) and tolerant (29%) patients (iii) DQ DSA associated with de novo autoimmune hepatitis and late acute rejection
Del Bello et al. (2015) [18]	Prospective	152 adult	14%	(i) Younger age, low exposure to calcineurin inhibitors, and noncompliance were risk factors for de novo DSA emergence (ii) Nine of 21 (43%) DSA-positive recipients developed acute rejection (iii) No differences in patient or graft survival with DSA presence
Levitsky et al. (2016) [19]	Retrospective analysis of an observational cohort study	195 adult (129 LDLT, 66 DDLT)	5.4% in LDLT; 6.1% in DDLT	(i) No differences in the prevalence of de novo DSA between LDLT and DDLT recipients (ii) Presence of DSA was an independent risk factor for graft failure in LDLT and DDLT

LDLT, living donor liver transplantation; DDLT, deceased donor liver transplantation.