{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T23:30:59Z","timestamp":1776209459553,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T00:00:00Z","timestamp":1645056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>The reported prevalence of autoantibodies (AAB) (ANA, SMA, LKM, SLA) after pediatric liver transplantation (pLTX) varies considerably from 26\u201375%, but their clinical impact on outcome is uncertain. We aimed to study the prevalence of AAB after pLTX, their association with donor-, transplant-, and recipient-characteristics, and their relation to outcome. In our multicenter retrospective study, we aimed to clarify conflicting results from earlier studies. Six ERN TransplantChild centers reported data on 242 patients, of whom 61% were AAB positive. Prevalence varied across these centers. Independent of the interval between pLTX and AAB analysis, a one-hour increase in CIT resulted in an odds ratio (OR) of 1.37 (95% CI 1.11\u20131.69) for SMA positivity and an OR of 1.42 (95%CI 1.18\u20131.72) for ANA positivity. Steroid-free immunosuppression (IS) versus steroid-including IS (OR 5.28; 95% CI 1.45\u201319.28) was a risk factor for SMA positivity. Liver enzymes were not associated with ANA or SMA positivity. We did not observe an association of rejection activity index with ANA or SMA. However, the liver fibrosis score in follow-up biopsies was associated with ANA titer and donor age. In conclusion, this first multicenter study on AAB after pLTX showed high AAB prevalence and varied widely between centers. Longer CIT and prednisolone-free-IS were associated with AAB positivity, whereas AAB were not indicative of rejection, but instead were associated with graft fibrosis. The detection of AAB may be a marker of liver fibrosis and may be taken into consideration when indications for liver biopsy and immunosuppressive regimes, or reduction of immunosuppression in long-term follow-up, are being discussed. Prospective immunological profiling of pLTX patients, including AAB, is important to further improve our understanding of transplant immunology and silent graft fibrosis.<\/jats:p>","DOI":"10.3390\/children9020275","type":"journal-article","created":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T20:24:26Z","timestamp":1645129466000},"page":"275","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cold Ischemia Time and Graft Fibrosis Are Associated with Autoantibodies after Pediatric Liver Transplantation: A Retrospective Cohort Study of the European Reference Network TransplantChild"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3099-2667","authenticated-orcid":false,"given":"Norman","family":"Junge","sequence":"first","affiliation":[{"name":"Division for Pediatric Gastroenterology and Hepatology, Department of Peadiatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelo","family":"Di Giorgio","sequence":"additional","affiliation":[{"name":"Department of Paediatric Hepatology, Gastroenterology and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muriel","family":"Girard","sequence":"additional","affiliation":[{"name":"H\u00e9patologie P\u00e9diatrique\u2013Transplantation H\u00e9patique, Hospital Necker Enfants-Malades, 75015 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeynep","family":"Demir","sequence":"additional","affiliation":[{"name":"H\u00e9patologie P\u00e9diatrique\u2013Transplantation H\u00e9patique, Hospital Necker Enfants-Malades, 75015 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diana","family":"Kaminska","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children\u2019s Memorial Health Institute, 04-730 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Janowska","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery & Organ Transplantation, The Children\u2019s Memorial Health Institute, 04-730 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaidotas","family":"Urbonas","sequence":"additional","affiliation":[{"name":"Clinic of Children\u2019s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominykas","family":"Varnas","sequence":"additional","affiliation":[{"name":"Clinic of Children\u2019s Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8201-2416","authenticated-orcid":false,"given":"Giuseppe","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Gastrointestinal, Liver, Nutrition Disorders Unit, Liver Transplantation Center, IRCCS Pediatric Hospital Bambino Ges\u00f9, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3082-855X","authenticated-orcid":false,"given":"Tommaso","family":"Alterio","sequence":"additional","affiliation":[{"name":"Gastrointestinal, Liver, Nutrition Disorders Unit, Liver Transplantation Center, IRCCS Pediatric Hospital Bambino Ges\u00f9, 00165 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Leiskau","sequence":"additional","affiliation":[{"name":"Division for Pediatric Gastroenterology and Hepatology, Department of Peadiatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany"},{"name":"Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center G\u00f6ttingen, Georg August University, 37075 G\u00f6ttingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian W. R.","family":"Vondran","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Richter","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7150-3148","authenticated-orcid":false,"given":"Lorenzo","family":"D\u2019Antiga","sequence":"additional","affiliation":[{"name":"Department of Paediatric Hepatology, Gastroenterology and Transplantation, Azienda Ospedaliera Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1271-7204","authenticated-orcid":false,"given":"Rafael","family":"Mikolajczyk","sequence":"additional","affiliation":[{"name":"Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, 06112 Halle, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva-Doreen","family":"Pfister","sequence":"additional","affiliation":[{"name":"Division for Pediatric Gastroenterology and Hepatology, Department of Peadiatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ulrich","family":"Baumann","sequence":"additional","affiliation":[{"name":"Division for Pediatric Gastroenterology and Hepatology, Department of Peadiatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Leiskau, C., Junge, N., Pfister, E., Goldschmidt, I., Mutschler, F., Laue, T., Ohlendorf, J., Nasser, H., Beneke, J., and Richter, N. 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