Antibody-mediated rejection in ABO compatible husband to wife living donor liver transplant and review of the literature
Abstract Role of donor specific antibodies (DSAs) in liver allograft function has not been fully defined. We report an ABO compatible orthotopic liver transplant case with DSAs to donor HLA, where the patient developed immediate antibody-mediated rejection (AMR).The patient, a 43-year-old female wit...
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| Veröffentlicht in: | Human immunology 2014-06, Vol.75 (6), p.578-583 |
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| creator | Kheradmand, T Anthony, T.L Harland, R.C Testa, G Hart, J Renz, J Te, H.S Marino, S.R |
| description | Abstract Role of donor specific antibodies (DSAs) in liver allograft function has not been fully defined. We report an ABO compatible orthotopic liver transplant case with DSAs to donor HLA, where the patient developed immediate antibody-mediated rejection (AMR).The patient, a 43-year-old female with cirrhosis, underwent ABO-compatible living-donor liver transplant from her husband. On post-operative day (POD)1, serum transaminases were sharply elevated. Retrospective testing of pre-transplant serum demonstrated presence of strong class I and class II anti-HLA antibodies and positive T- and B-cell flow-cytometric crossmatches (FCXM). Transaminase levels improved with plasmapheresis and thymoglobulin. On POD7, her liver enzymes became elevated again and allograft biopsy stained positive for C4d. Patient was treated with intravenous immunoglobulin and rituximab and recovered over time. Pre-transplant sera of patient were retrospectively tested by C1q assay to determine the cytotoxic function of DSAs; DSAs were positive for C1q binding. Our results suggest that pre-liver transplant antibody testing may be helpful in identifying patients at risk for development of AMR. |
| doi_str_mv | 10.1016/j.humimm.2014.02.010 |
| format | Article |
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We report an ABO compatible orthotopic liver transplant case with DSAs to donor HLA, where the patient developed immediate antibody-mediated rejection (AMR).The patient, a 43-year-old female with cirrhosis, underwent ABO-compatible living-donor liver transplant from her husband. On post-operative day (POD)1, serum transaminases were sharply elevated. Retrospective testing of pre-transplant serum demonstrated presence of strong class I and class II anti-HLA antibodies and positive T- and B-cell flow-cytometric crossmatches (FCXM). Transaminase levels improved with plasmapheresis and thymoglobulin. On POD7, her liver enzymes became elevated again and allograft biopsy stained positive for C4d. Patient was treated with intravenous immunoglobulin and rituximab and recovered over time. Pre-transplant sera of patient were retrospectively tested by C1q assay to determine the cytotoxic function of DSAs; DSAs were positive for C1q binding. Our results suggest that pre-liver transplant antibody testing may be helpful in identifying patients at risk for development of AMR.</description><identifier>ISSN: 0198-8859</identifier><identifier>EISSN: 1879-1166</identifier><identifier>DOI: 10.1016/j.humimm.2014.02.010</identifier><identifier>PMID: 24530823</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>ABO Blood-Group System - immunology ; Adult ; Allergy and Immunology ; Autoantibodies - blood ; B-Lymphocytes - immunology ; B-Lymphocytes - pathology ; Complement C4b ; Female ; Graft Rejection - immunology ; Graft Rejection - pathology ; Graft Rejection - therapy ; Histocompatibility Testing ; HLA Antigens - immunology ; Humans ; Immunoglobulins, Intravenous - therapeutic use ; Isoantibodies - blood ; Liver Cirrhosis - immunology ; Liver Cirrhosis - pathology ; Liver Cirrhosis - surgery ; Liver Transplantation ; Living Donors ; Male ; Peptide Fragments - blood ; Plasmapheresis ; Spouses ; T-Lymphocytes - immunology ; T-Lymphocytes - pathology ; Transaminases - blood ; Transplantation, Homologous</subject><ispartof>Human immunology, 2014-06, Vol.75 (6), p.578-583</ispartof><rights>American Society for Histocompatibility and Immunogenetics</rights><rights>2014 American Society for Histocompatibility and Immunogenetics</rights><rights>Copyright © 2014 American Society for Histocompatibility and Immunogenetics. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c483t-167607925f7246358f3849e35fd80989f54b2619bdc4d925151f22691534de7f3</citedby><cites>FETCH-LOGICAL-c483t-167607925f7246358f3849e35fd80989f54b2619bdc4d925151f22691534de7f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.humimm.2014.02.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24530823$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kheradmand, T</creatorcontrib><creatorcontrib>Anthony, T.L</creatorcontrib><creatorcontrib>Harland, R.C</creatorcontrib><creatorcontrib>Testa, G</creatorcontrib><creatorcontrib>Hart, J</creatorcontrib><creatorcontrib>Renz, J</creatorcontrib><creatorcontrib>Te, H.S</creatorcontrib><creatorcontrib>Marino, S.R</creatorcontrib><title>Antibody-mediated rejection in ABO compatible husband to wife living donor liver transplant and review of the literature</title><title>Human immunology</title><addtitle>Hum Immunol</addtitle><description>Abstract Role of donor specific antibodies (DSAs) in liver allograft function has not been fully defined. We report an ABO compatible orthotopic liver transplant case with DSAs to donor HLA, where the patient developed immediate antibody-mediated rejection (AMR).The patient, a 43-year-old female with cirrhosis, underwent ABO-compatible living-donor liver transplant from her husband. On post-operative day (POD)1, serum transaminases were sharply elevated. Retrospective testing of pre-transplant serum demonstrated presence of strong class I and class II anti-HLA antibodies and positive T- and B-cell flow-cytometric crossmatches (FCXM). Transaminase levels improved with plasmapheresis and thymoglobulin. On POD7, her liver enzymes became elevated again and allograft biopsy stained positive for C4d. Patient was treated with intravenous immunoglobulin and rituximab and recovered over time. Pre-transplant sera of patient were retrospectively tested by C1q assay to determine the cytotoxic function of DSAs; DSAs were positive for C1q binding. Our results suggest that pre-liver transplant antibody testing may be helpful in identifying patients at risk for development of AMR.</description><subject>ABO Blood-Group System - immunology</subject><subject>Adult</subject><subject>Allergy and Immunology</subject><subject>Autoantibodies - blood</subject><subject>B-Lymphocytes - immunology</subject><subject>B-Lymphocytes - pathology</subject><subject>Complement C4b</subject><subject>Female</subject><subject>Graft Rejection - immunology</subject><subject>Graft Rejection - pathology</subject><subject>Graft Rejection - therapy</subject><subject>Histocompatibility Testing</subject><subject>HLA Antigens - immunology</subject><subject>Humans</subject><subject>Immunoglobulins, Intravenous - therapeutic use</subject><subject>Isoantibodies - blood</subject><subject>Liver Cirrhosis - immunology</subject><subject>Liver Cirrhosis - pathology</subject><subject>Liver Cirrhosis - surgery</subject><subject>Liver Transplantation</subject><subject>Living Donors</subject><subject>Male</subject><subject>Peptide Fragments - blood</subject><subject>Plasmapheresis</subject><subject>Spouses</subject><subject>T-Lymphocytes - immunology</subject><subject>T-Lymphocytes - pathology</subject><subject>Transaminases - blood</subject><subject>Transplantation, Homologous</subject><issn>0198-8859</issn><issn>1879-1166</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUGP1CAYhonRuLOr_8AYjl5agdIWLibjRl2TTfagnkkLHw61hRHorvPvpZnVgxdPhOR5vw-eF6FXlNSU0O7tVB_WxS1LzQjlNWE1oeQJ2lHRy4rSrnuKdoRKUQnRygt0mdJECOlJz5-jC8bbhgjW7NCvvc9uDOZULWDckMHgCBPo7ILHzuP9-zusw3IcCjUDPqxpHLzBOeAHZwHP7t7579gEH-J2gYhzHHw6zoPPeCMj3Dt4wMHifNj4DHHIa4QX6Jkd5gQvH88r9O3jh6_XN9Xt3afP1_vbSnPR5Ip2fUd6yVrbM941rbCN4BKa1hpBpJC25SPrqByN5qZgtKWWsU7StuEGettcoTfnuccYfq6Qslpc0jCXB0JYk6JtiTNJuCwoP6M6hpQiWHWMbhniSVGiNudqUmfnanOuCFPFeYm9ftywjkXi39AfyQV4dwag_LPYiCppB14X4bGYVia4_234d4CenXd6mH_ACdIU1uiLQ0VVKgH1Zet9q53yUnnR1PwGddWpgQ</recordid><startdate>20140601</startdate><enddate>20140601</enddate><creator>Kheradmand, T</creator><creator>Anthony, T.L</creator><creator>Harland, R.C</creator><creator>Testa, G</creator><creator>Hart, J</creator><creator>Renz, J</creator><creator>Te, H.S</creator><creator>Marino, S.R</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140601</creationdate><title>Antibody-mediated rejection in ABO compatible husband to wife living donor liver transplant and review of the literature</title><author>Kheradmand, T ; Anthony, T.L ; Harland, R.C ; Testa, G ; Hart, J ; Renz, J ; Te, H.S ; Marino, S.R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c483t-167607925f7246358f3849e35fd80989f54b2619bdc4d925151f22691534de7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>ABO Blood-Group System - immunology</topic><topic>Adult</topic><topic>Allergy and Immunology</topic><topic>Autoantibodies - blood</topic><topic>B-Lymphocytes - immunology</topic><topic>B-Lymphocytes - pathology</topic><topic>Complement C4b</topic><topic>Female</topic><topic>Graft Rejection - immunology</topic><topic>Graft Rejection - pathology</topic><topic>Graft Rejection - therapy</topic><topic>Histocompatibility Testing</topic><topic>HLA Antigens - immunology</topic><topic>Humans</topic><topic>Immunoglobulins, Intravenous - therapeutic use</topic><topic>Isoantibodies - blood</topic><topic>Liver Cirrhosis - immunology</topic><topic>Liver Cirrhosis - pathology</topic><topic>Liver Cirrhosis - surgery</topic><topic>Liver Transplantation</topic><topic>Living Donors</topic><topic>Male</topic><topic>Peptide Fragments - blood</topic><topic>Plasmapheresis</topic><topic>Spouses</topic><topic>T-Lymphocytes - immunology</topic><topic>T-Lymphocytes - pathology</topic><topic>Transaminases - blood</topic><topic>Transplantation, Homologous</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kheradmand, T</creatorcontrib><creatorcontrib>Anthony, T.L</creatorcontrib><creatorcontrib>Harland, R.C</creatorcontrib><creatorcontrib>Testa, G</creatorcontrib><creatorcontrib>Hart, J</creatorcontrib><creatorcontrib>Renz, J</creatorcontrib><creatorcontrib>Te, H.S</creatorcontrib><creatorcontrib>Marino, S.R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Human immunology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kheradmand, T</au><au>Anthony, T.L</au><au>Harland, R.C</au><au>Testa, G</au><au>Hart, J</au><au>Renz, J</au><au>Te, H.S</au><au>Marino, S.R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antibody-mediated rejection in ABO compatible husband to wife living donor liver transplant and review of the literature</atitle><jtitle>Human immunology</jtitle><addtitle>Hum Immunol</addtitle><date>2014-06-01</date><risdate>2014</risdate><volume>75</volume><issue>6</issue><spage>578</spage><epage>583</epage><pages>578-583</pages><issn>0198-8859</issn><eissn>1879-1166</eissn><abstract>Abstract Role of donor specific antibodies (DSAs) in liver allograft function has not been fully defined. We report an ABO compatible orthotopic liver transplant case with DSAs to donor HLA, where the patient developed immediate antibody-mediated rejection (AMR).The patient, a 43-year-old female with cirrhosis, underwent ABO-compatible living-donor liver transplant from her husband. On post-operative day (POD)1, serum transaminases were sharply elevated. Retrospective testing of pre-transplant serum demonstrated presence of strong class I and class II anti-HLA antibodies and positive T- and B-cell flow-cytometric crossmatches (FCXM). Transaminase levels improved with plasmapheresis and thymoglobulin. On POD7, her liver enzymes became elevated again and allograft biopsy stained positive for C4d. Patient was treated with intravenous immunoglobulin and rituximab and recovered over time. Pre-transplant sera of patient were retrospectively tested by C1q assay to determine the cytotoxic function of DSAs; DSAs were positive for C1q binding. Our results suggest that pre-liver transplant antibody testing may be helpful in identifying patients at risk for development of AMR.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24530823</pmid><doi>10.1016/j.humimm.2014.02.010</doi><tpages>6</tpages></addata></record> |
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| subjects | ABO Blood-Group System - immunology Adult Allergy and Immunology Autoantibodies - blood B-Lymphocytes - immunology B-Lymphocytes - pathology Complement C4b Female Graft Rejection - immunology Graft Rejection - pathology Graft Rejection - therapy Histocompatibility Testing HLA Antigens - immunology Humans Immunoglobulins, Intravenous - therapeutic use Isoantibodies - blood Liver Cirrhosis - immunology Liver Cirrhosis - pathology Liver Cirrhosis - surgery Liver Transplantation Living Donors Male Peptide Fragments - blood Plasmapheresis Spouses T-Lymphocytes - immunology T-Lymphocytes - pathology Transaminases - blood Transplantation, Homologous |
| title | Antibody-mediated rejection in ABO compatible husband to wife living donor liver transplant and review of the literature |
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