title: Antibody-mediated rejection in ABO compatible husband to wife living donor liver transplant and review of the literature.
abstract: Role of donor specific antibodies (DSAs) in liver allograft function has not been fully defined. We report an ABO compatible orthotopic liver transplant case with DSAs to donor HLA, where the patient developed immediate antibody-mediated rejection (AMR).The patient, a 43-year-old female with cirrhosis, underwent ABO-compatible living-donor liver transplant from her husband. On post-operative day (POD)1, serum transaminases were sharply elevated. Retrospective testing of pre-transplant serum demonstrated presence of strong class I and class II anti-HLA antibodies and positive T- and B-cell flow-cytometric crossmatches (FCXM). Transaminase levels improved with plasmapheresis and thymoglobulin. On POD7, her liver enzymes became elevated again and allograft biopsy stained positive for C4d. Patient was treated with intravenous immunoglobulin and rituximab and recovered over time. Pre-transplant sera of patient were retrospectively tested by C1q assay to determine the cytotoxic function of DSAs; DSAs were positive for C1q binding. Our results suggest that pre-liver transplant antibody testing may be helpful in identifying patients at risk for development of AMR.
authors: Department of Pathology, University of Chicago Medicine, Chicago, IL, United States.
authors: T
authors: T
authors: Kheradmand
authors: Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States.
authors: T L
authors: TL
authors: Anthony
authors: Department of Surgery, East Carolina University, Greenville, NC, United States.
authors: R C
authors: RC
authors: Harland
authors: Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, United States.
authors: G
authors: G
authors: Testa
authors: Department of Pathology, University of Chicago Medicine, Chicago, IL, United States.
authors: J
authors: J
authors: Hart
authors: Department of Surgery, University of Chicago Medicine, Chicago, IL, United States.
authors: J
authors: J
authors: Renz
authors: Department of Medicine, University of Chicago Medicine, Chicago, IL, United States.
authors: H S
authors: HS
authors: Te
authors: Department of Pathology, University of Chicago Medicine, Chicago, IL, United States. Electronic address: smarino@bsd.uchicago.edu.
authors: S R
authors: SR
authors: Marino
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D001402:B-Lymphocytes / Q000276:immunology / Q000473:pathology; D015935:Complement C4b; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000473:pathology / Q000628:therapy; D006680:HLA Antigens / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007518:Isoantibodies / Q000097:blood*; D008103:Liver Cirrhosis / Q000276:immunology / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D010446:Peptide Fragments / Q000097:blood; D010956:Plasmapheresis; D018454:Spouses; D013601:T-Lymphocytes / Q000276:immunology / Q000473:pathology; D000637:Transaminases / Q000097:blood; D014184:Transplantation, Homologous
chemical_list: D000017:ABO Blood-Group System; D001323:Autoantibodies; D006680:HLA Antigens; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d; D000637:Transaminases