title: Retransplant as Rescue Treatment for ABO-Compatible Living-Donor Liver Transplant Related Antibody-Mediated Rejection: A Case Report.
abstract: Antibody-mediated rejection after liver transplant, especially when the donor is not a direct relative; it is associated with additional inconvenience for patients. We encountered a case in which antibody-mediated rejection because of de novo donor specific antibodies against donor human leukocyte antigen developed 6 months after ABO-compatible living-donor liver transplant and was treated with retransplant. A 38-year-old man with hepatitis B virus-related hepatocellular carcinoma underwent living-donor liver transplant with a graft from his wife. Six months later, he experienced fatigue and jaundice. Liver biopsy revealed C4d deposits, and histologic examination showed an antibody-mediated rejection pattern. We re-evaluated recipient-donor human leukocyte antigen matching and tested the patient's blood for antihuman leukocyte antigen donor-specific antibodies against donor human leukocyte antigen. De novo auto-antibodies against human leukocyte antigen-DQ6 were identified by Luminex single antigen beads.Because exhausting all treatment options, a rescue second living-donor liver transplant was planned with the patient's stepdaughter as the donor. Pretransplant human leukocyte antigen matching was performed, and the patient was discharged without event. Two months later, hyperbilirubinemia was noted, and a residual common bile duct from the first donor with chronic fibrosis and stricture was strongly suspected. Redo hepaticojejunostomy was successfully performed, with no problems during 1-years' follow-up. Thus, liver retransplant could be a rescue treatment for antibody-mediated rejection complicated with hepatic failure.
authors.affiliation: From the Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Meng-Hsing
authors.initials: MH
authors.lastname: Ho
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Wu
authors.forename: Kuang-Wen
authors.initials: KW
authors.lastname: Ou
authors.forename: Ting-Fu
authors.initials: TF
authors.lastname: Su
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001323:Autoantibodies / Q000276:immunology*; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000821:virology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D006085:Graft Survival; D006680:HLA Antigens / Q000276:immunology*; D006509:Hepatitis B / Q000150:complications; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D001323:Autoantibodies; D006680:HLA Antigens