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KMID : 0361120180320040108
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Korean Journal of Transplantation
2018 Volume.32 No. 4 p.108 ~ p.112
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Donor Specific Antibody Negative Antibody-Mediated Rejection after ABO Incompatible Liver Transplantation
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Lee Bo-Ram
Ahn Soo-Min
Kim Hae-Ryoung
Han Ho-Seong
Yoon Yoo-Seok
Cho Jai-Young
Choi Young-Rok
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Abstract
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Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.
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KEYWORD
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Liver transplantation, Antibody-dependent cell cytotoxicity, Rejection, Living donors, HLA antigens
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