J Korean Soc Transplant.  2012 Mar;26(1):6-9. 10.4285/jkstn.2012.26.1.6.

The Diagnosis of Acute Antibody-Mediated Rejection in ABO-Incompatible Liver Transplants

• Kwon GY

• KMID: 1435076
• DOI: http://doi.org/10.4285/jkstn.2012.26.1.6

Abstract

Liver transplantation (LT) across the ABO-blood type barrier is prone to antibody-mediated rejection (AMR), which often leads to a deleterious clinical outcome. While it is of paramount importance to make an early diagnosis of AMR, the morphologic features of AMR in the liver are not specific, and the differential diagnosis is often difficult or even impossible on a morphologic basis alone. The clinical utility of C4d immunostaining is limited in the liver, unlike other organs, further complicating the situation. Therefore, the diagnosis of AMR in the liver requires integration of clinical, morphologic, immunopathologic, and serological evidence.

Keyword

ABO-incompatible; Transplantation; Liver; Acute antibody-mediated rejection; C4d

MeSH Terms

Diagnosis, Differential
Early Diagnosis
Liver
Liver Transplantation
Rejection (Psychology)
Transplants

Figure

• 

  Fig. 1 Histologic features of morphologically severe preservation injury simulating AMR. Above findings are from protocol biopsy of 1 week post-transplant after ABOi LT. Portal tract shows activated endothelial cells (curved arrow) and granulocytic infiltrates (straight arrow). These findings are suggestive of AMR, however, in this patient, the level of serum transaminase was withing normal limits and C4d-immunostaining was negative. Final diagnosis of preservation injury was rendered (H&E, ×400).

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