Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation

R. Watson, T. Kozlowski, V. Nickeleit, J. T. Woosley, J. L. Schmitz, S. L. Zacks, J. H. Fair, D. A. Gerber, K. A. Andreoni

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


Antibody-mediated rejection (AMR) after liver transplantation is recognized in ABO incompatible and xeno-transplantation, but its role after ABO compatible liver transplantation is controversial. We report a case of ABO compatible liver transplantation that demonstrated clinical, serological and histological signs of AMR without evidence of concurrent acute cellular rejection. AMR with persistently high titers of circulating donor specific antibodies resulted in graft injury with initial centrilobular hepatocyte necrosis, fibroedematous portal expansion mimicking biliary tract outflow obstruction, ultimately resulting in extensive bridging fibrosis. Immunofluorescence microscopy demonstrated persistent, diffuse linear C4d deposits along sinusoids and central veins. Despite intense therapeutic intervention including plasmapheresis, IVIG and rituximab, AMR led to graft failure. We present evidence that an antibody-mediated alloresponse to an ABO compatible liver graft can cause significant graft injury independent of acute cellular rejection. AMR shows distinct histologic changes including a characteristic staining profile for C4d.

Original languageEnglish (US)
Pages (from-to)3022-3029
Number of pages8
JournalAmerican Journal of Transplantation
Issue number12
StatePublished - Dec 2006
Externally publishedYes


  • Antibody mediated rejection
  • Complement C4d
  • Immunohistochemistry
  • Liver graft rejection
  • Liver transplantation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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