Pathogenesis in ABO incompatible liver transplantation: a clinicohistological evaluation of four patients.
The aim of this study was to clarify the pathogenesis of antibody-mediated rejection (AMR) of ABO-incompatible liver transplantation (ABO-I-LT). We investigated, within one month of surgery, the clinical courses of 10 patients who received ABO-I-LT. We encountered four cases of AMR, which were classified into two groups according to the stage of the AMR: early (within the first 14 postoperative days [PODs]) or late (after the 14th POD). There were three patients in the early stage, and one patient in the late stage. Three early-stage AMR patients had both hyperbilirubinemia and thrombocytopenia within one month after LDLT, but the one late-stage AMR patient had neither. On liver biopsy, hemorrhagic infiltration was seen more frequently in the early-stage AMR patients than in the patient with late-stage AMR. Plasma exchange combined with a large amount of gamma-globulin bolus infusion therapy was effective in the three early-stage patients, but the late-stage AMR was controlled by antibiotic treatment. This study showed that the early-stage AMR resulted from the antigen-antibody reaction of ABO-blood-group antigens, while the late-stage AMR may have been caused by an infection.
Takeda
Kazuhisa
K
Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Fukuura, Kanazawa-ku, Yokohama, Japan. kazutake@yokohama-cu.ac.jp
Tanaka
Kuniya
K
Morioka
Daisuke
D
Kumamoto
Takafumi
T
Endo
Itaru
I
Togo
Shinji
S
Shimada
Hiroshi
H
D000017:ABO Blood-Group System / Q000276:immunology*; D000368:Aged; D000937:Antigen-Antibody Reactions; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged
D000017:ABO Blood-Group System