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. 2011 Mar;11(3):500-10.
doi: 10.1111/j.1600-6143.2010.03414.x.

The significance of donor-specific HLA antibodies in rejection and ductopenia development in ABO compatible liver transplantation

A I Musat  1 , R M Agni, P Y Wai, J D Pirsch, D F Lorentzen, A Powell, G E Leverson, J M Bellingham, L A Fernandez, D P Foley, J D Mezrich, A M D'Alessandro, M R Lucey
Affiliations

The significance of donor-specific HLA antibodies in rejection and ductopenia development in ABO compatible liver transplantation

A I Musat et al. Am J Transplant. 2011 Mar.

Abstract

The role of humoral alloreactivity in ABO-compatible liver transplantation remains unclear. To understand the significance of donor-specific HLA alloantibodies (DSA) in liver rejection, we applied the currently used strategy for detection of antibody-mediated rejection of other solid allografts. For this purpose we reviewed the data on 43 recipients of ABO identical/compatible donor livers who had indication liver biopsy stained for complement element C4d and contemporaneous circulating DSA determination. Seventeen (40%) patients had significant circulating DSA in association with diffuse portal C4d deposition (DSA+/diffuse C4d+). These DSA+/diffuse C4d+ subjects had higher frequency of acute cellular rejection (ACR) 15/17 versus 13/26 (88% vs. 50%), p = 0.02, and steroid resistant rejection 7/17 versus 5/26 (41% vs. 19%), p = 0.03. Based on detection of the combination DSA+/diffuse C4d+, 53.6% of cases of ACR had evidence of concurrent humoral alloreactivity. Six of the 10 patients with ductopenic rejection had circulating DSA and diffuse portal C4d, three of whom (2 early and 1 late posttransplantation) developed unrelenting cholestasis, necessitating specific antibody-depleting therapy to salvage the allografts. Thus, in ABO-compatible liver transplantation humoral alloreactivity mediated by antibodies against donor HLA molecules appears to be frequently intertwined with cellular mechanisms of rejection, and to play a role in ductopenia development.

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Conflict of interest statement

Disclosure: The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1. Patterns of C4d deposition
Immunolabeling of portal capillaries and nearby stroma (A and B). Strong staining of the portal vein endothelium (C). Sinusoidal endothelium staining (D).
See this image and copyright information in PMC

Comment in

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