title: Diagnostics and treatment of a severe humoral rejection after liver transplantation: donor-specific antibodies as a still underestimated cause of graft failure.
abstract: BACKGROUND
  Donor-specific antibodies (DSAs) are increasingly being considered a cause of complications after liver transplant (LT). However, neither monitoring of DSAs nor the appropriate therapeutic procedures for humoral graft damage are yet standardized. Here we report a case of DSA-positive humoral rejection after LT that was successfully treated with plasmapheresis and immunoglobulins.
  
  
  METHODS
  Human leukocyte antigen (HLA)-specific DSAs were detected by Luminex bead assay. Patient characteristics, laboratory values, and data about the patient's general condition were documented from April 2013 to June 2015.
  
  
  METHODS
  Eighteen months after LT, a 54-year-old man experienced severe hepatopathy with rapidly increasing transaminase activity and total bilirubin levels. Histologic findings were inconclusive, demonstrating chronic cholestasis and minimal positive staining for C4 d. However, an analysis for anti-HLA antibodies detected DSAs against HLA class II molecules with high mean fluorescence intensity. The patient underwent 8 courses of plasmapheresis, resulting in sustained amelioration of his condition and decreases in bilirubin levels and transaminase activity.
  
  
  CONCLUSIONS
  De novo DSAs can be responsible for graft failure after LT. Thus, procedures aimed at detecting DSAs are recommended, and regular monitoring of DSAs after LT is important for individualized risk management. Plasmapheresis is an efficient therapeutic procedure for DSA-associated graft failure.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Rashidi-Alavijeh
authors.affiliation: Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Heinold
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Willuweit
authors.affiliation: Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: H A
authors.initials: HA
authors.lastname: Baba
authors.affiliation: Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: P A
authors.initials: PA
authors.lastname: Horn
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Paul
authors.affiliation: Department of Infectious Diseases and Department of Nephrology, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Witzke
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Gerken
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Essen, University of Duisburg-Essen, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Herzer
mesh_terms: D001323:Autoantibodies / Q000276:immunology; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology* / Q000628:therapy*; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D056724:Immunity, Humoral / Q000276:immunology*; D007136:Immunoglobulins / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis / Q000379:methods; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D001323:Autoantibodies; D006680:HLA Antigens; D007136:Immunoglobulins