title: Histological long-term outcomes from acute antibody-mediated rejection following ABO-compatible liver transplantation.
abstract: OBJECTIVE
  Acute antibody-mediated rejection (aAMR) is an unusual complication after orthotopic ABO-compatible liver transplantation. To date, the clinical and histological long-term outcomes after aAMR are not well known.
  
  
  METHODS
  Herein, we describe nine cases of aAMR that occurred in our liver-transplant center between 2008 and 2016, with an initial and reevaluation liver biopsy available for reexamination.
  
  
  RESULTS
  Two patients presented with aAMR at 10.5 (10, 11) days post-transplantation, caused by preformed donor-specific antibodies. Seven other recipients developed de novo donor-specific antibodies and aAMR at 11.2 (3-24) months post-transplantation. Eight of the nine patients received a B-cell targeting agent (rituximab, with or without plasma exchange), associated with polyclonal antibodies (three patients) or intravenous immunoglobulins (three patients). At the last follow up (i.e. 21 [4-90] months post-aAMR), seven patients were alive, including two patients with normal liver tests. Grafts' survival was 66%. A liver biopsy performed at 11.5 (5-48.5) months after the first biopsy showed no significant improvement in aAMR score (from 2 ± 1.3 to 1.6 ± 1.5, P = 0.6), a significant improvement in chronic AMR score (from 37 ± 9 to 25 ± 8, P = 0.003) and an increase in the Metavir score (1.2 ± 0.6 to 2.1 ± 0.9, P = 0.03).
  
  
  CONCLUSIONS
  In this study, a B-cell-depleting agent seemed to improve the prognosis of aAMR in selected cases, but several patients kept active lesions antibody-mediated rejection.
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Del Bello
authors.affiliation: Department of Pathology, Cancer University Institute of Toulouse Oncopole, CHU, Toulouse, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Danjoux
authors.affiliation: Molecular Immunogenetics Laboratory, EA 3034, Faculty of Medicine Purpan, IFR150 (INSERM), Toulouse, France.|Department of Immunology, Hospital Rangueil, CHU, Toulouse, France.|Paul Sabatier University, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Congy-Jolivet
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lavayssière
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Esposito
authors.affiliation: Paul Sabatier University, Toulouse, France.|Department of Surgery and Liver Transplantation, Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.affiliation: Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.|Paul Sabatier University, Toulouse, France.|INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kamar
mesh_terms: D000017:ABO Blood-Group System; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000276:immunology; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000276:immunology* / Q000628:therapy*; D006085:Graft Survival; D006648:Histocompatibility; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D000069283:Rituximab / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D000069283:Rituximab
keywords: B-cell targeting agent; antibody-mediated rejection; donor-specific antibodies; liver biopsy; liver transplantation