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, Jeffrey Fair, D. A. Gerber, K. A. Andreoni

Research output: Contribution to journalArticle

73 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)3022-3029
Number of pages8
JournalAmerican Journal of Transplantation
Volume6
Issue number12
DOIs
StatePublished - Dec 2006
Externally publishedYes

Fingerprint

Isoantibodies
Liver Transplantation
Antibodies
Transplants
Plasmapheresis
Intravenous Immunoglobulins
Wounds and Injuries
Biliary Tract
Fluorescence Microscopy
Hepatocytes
Veins
Fibrosis
Necrosis
Transplantation
Staining and Labeling
Liver

Keywords

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

ASJC Scopus subject areas

  • Immunology

Cite this

Watson, R., Kozlowski, T., Nickeleit, V., Woosley, J. T., Schmitz, J. L., Zacks, S. L., ... Andreoni, K. A. (2006). Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation. American Journal of Transplantation, 6(12), 3022-3029. https://doi.org/10.1111/j.1600-6143.2006.01554.x

Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation. / Watson, R.; Kozlowski, T.; Nickeleit, V.; Woosley, J. T.; Schmitz, J. L.; Zacks, S. L.; Fair, Jeffrey; Gerber, D. A.; Andreoni, K. A.

In: American Journal of Transplantation, Vol. 6, No. 12, 12.2006, p. 3022-3029.

Research output: Contribution to journalArticle

Watson, R, Kozlowski, T, Nickeleit, V, Woosley, JT, Schmitz, JL, Zacks, SL, Fair, J, Gerber, DA & Andreoni, KA 2006, 'Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation', American Journal of Transplantation, vol. 6, no. 12, pp. 3022-3029. https://doi.org/10.1111/j.1600-6143.2006.01554.x
Watson, R. ; Kozlowski, T. ; Nickeleit, V. ; Woosley, J. T. ; Schmitz, J. L. ; Zacks, S. L. ; Fair, Jeffrey ; Gerber, D. A. ; Andreoni, K. A. / Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation. In: American Journal of Transplantation. 2006 ; Vol. 6, No. 12. pp. 3022-3029.
@article{f7e5414986a04fea9ca1048be861cee1,
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 Jeffrey Fair and Gerber, {D. A.} and Andreoni, {K. A.}",
year = "2006",
month = "12",
doi = "10.1111/j.1600-6143.2006.01554.x",
language = "English (US)",
volume = "6",
pages = "3022--3029",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation

AU - Watson, R.

AU - Kozlowski, T.

AU - Nickeleit, V.

AU - Woosley, J. T.

AU - Schmitz, J. L.

AU - Zacks, S. L.

AU - Fair, Jeffrey

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

UR - http://www.scopus.com/inward/record.url?scp=33751176696&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33751176696&partnerID=8YFLogxK

U2 - 10.1111/j.1600-6143.2006.01554.x

DO - 10.1111/j.1600-6143.2006.01554.x

M3 - Article

VL - 6

SP - 3022

EP - 3029

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 12

ER -