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

doi:10.1111/j.1600-6143.2006.01554.x

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 journal › Article › peer-review

77 Scopus citations

Abstract

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 language	English (US)
Pages (from-to)	3022-3029
Number of pages	8
Journal	American Journal of Transplantation
Volume	6
Issue number	12
DOIs	https://doi.org/10.1111/j.1600-6143.2006.01554.x
State	Published - Dec 2006
Externally published	Yes

Keywords

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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10.1111/j.1600-6143.2006.01554.x

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title = "Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation",

abstract = "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.",

keywords = "Antibody mediated rejection, Complement C4d, Immunohistochemistry, Liver graft rejection, Liver transplantation",

author = "R. Watson and T. Kozlowski and V. Nickeleit and Woosley, {J. T.} and Schmitz, {J. L.} and Zacks, {S. L.} and Fair, {J. H.} and Gerber, {D. A.} and Andreoni, {K. A.}",

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doi = "10.1111/j.1600-6143.2006.01554.x",

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AU - Watson, R.

AU - Kozlowski, T.

AU - Nickeleit, V.

AU - Woosley, J. T.

AU - Schmitz, J. L.

AU - Zacks, S. L.

AU - Fair, J. H.

AU - Gerber, D. A.

AU - Andreoni, K. A.

PY - 2006/12

Y1 - 2006/12

N2 - 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.

AB - 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.

KW - Antibody mediated rejection

KW - Complement C4d

KW - Immunohistochemistry

KW - Liver graft rejection

KW - Liver transplantation

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

Abstract

Keywords

ASJC Scopus subject areas

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