Isolated Donor Specific Alloantibody-Mediated Rejection after ABO Compatible Liver Transplantation
Article first published online: 25 OCT 2006
American Journal of Transplantation
Volume 6, Issue 12, pages 3022–3029, December 2006
How to Cite
Watson, R., Kozlowski, T., Nickeleit, V., Woosley, J. T., Schmitz, J. L., Zacks, S. L., Fair, J. H., Gerber, D. A. and Andreoni, K. A. (2006), Isolated Donor Specific Alloantibody-Mediated Rejection after ABO Compatible Liver Transplantation. American Journal of Transplantation, 6: 3022–3029. doi: 10.1111/j.1600-6143.2006.01554.x
- Issue published online: 16 NOV 2006
- Article first published online: 25 OCT 2006
- Received 14 April 2006, revised 28 July 2006 and accepted for publication 14 August 2006
- Antibody mediated rejection;
- complement C4d;
- liver graft rejection;
- liver transplantation
Antibody-mediated rejection (AMR) after liver transplantation is recognized in ABO incompatible and xeno-transplantation, but its role after ABO compatible liver transplantation is controversial.
We report a case of ABO compatible liver transplantation that demonstrated clinical, serological and histological signs of AMR without evidence of concurrent acute cellular rejection. AMR with persistently high titers of circulating donor specific antibodies resulted in graft injury with initial centrilobular hepatocyte necrosis, fibroedematous portal expansion mimicking biliary tract outflow obstruction, ultimately resulting in extensive bridging fibrosis. Immunofluorescence microscopy demonstrated persistent, diffuse linear C4d deposits along sinusoids and central veins. Despite intense therapeutic intervention including plasmapheresis, IVIG and rituximab, AMR led to graft failure.
We present evidence that an antibody-mediated alloresponse to an ABO compatible liver graft can cause significant graft injury independent of acute cellular rejection. AMR shows distinct histologic changes including a characteristic staining profile for C4d.