title: Liver allograft antibody-mediated rejection with demonstration of sinusoidal C4d staining and circulating donor-specific antibodies.
abstract: The importance of antibody-mediated rejection (AMR) in ABO-compatible liver transplantation is controversial. Here we report a prospective series of liver recipients with a preoperative positive crossmatch. To establish the diagnosis of AMR in liver recipients, the criteria described for kidney allografts were adopted. In approximately 10% of 197 liver transplants, we observed a positive T and B cell flow crossmatch before transplantation. Fifteen of 19 patients converted to negative crossmatches early after transplantation and displayed normal liver function while they were on routine immunosuppression. Four patients maintained positive crossmatches. Three of the 4 met the criteria for AMR and showed evidence of graft dysfunction, the presence of donor-specific antibodies (DSAs), morphological tissue destruction with positive C4d linear staining on the graft sinusoidal endothelium, and improved function with attempts to eliminate DSAs. A persistently positive crossmatch after liver transplantation may lead to early, severe AMR and liver failure. C4d staining in the liver sinusoidal endothelium should alert one to the possibility of AMR. In our experience, patients with a positive crossmatch should have it repeated at 2 weeks and, if it is positive, again at 3 to 5 weeks. Recipients with an unknown preoperative crossmatch who develop early cholestasis of unclear etiology should be crossmatched or tested for the presence of DSAs to evaluate for AMR.
authors: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7211, USA. tomasz_kozlowski@med.unc.edu
authors: Tomasz
authors: T
authors: Kozlowski
authors: Tara
authors: T
authors: Rubinas
authors: Volker
authors: V
authors: Nickeleit
authors: John
authors: J
authors: Woosley
authors: John
authors: J
authors: Schmitz
authors: Dana
authors: D
authors: Collins
authors: Paul
authors: P
authors: Hayashi
authors: Anthony
authors: A
authors: Passannante
authors: Kenneth
authors: K
authors: Andreoni
mesh_terms: D000328:Adult; D015935:Complement C4b / Q000032:analysis*; D006084:Graft Rejection / Q000209:etiology*; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood / Q000276:immunology*; D016031:Liver Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis*; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d