J Korean Soc Transplant.  2017 Mar;31(1):1-5. 10.4285/jkstn.2017.31.1.1.

What Is Antibody-Mediated Rejection in Histologic Diagnosis in Liver Recipients?

• Lee KB

• KMID: 2375674
• DOI: http://doi.org/10.4285/jkstn.2017.31.1.1

Abstract

Antibody-mediated rejection (AMR) is a rare event in liver transplantation compared to other solid organs such as the kidney and heart because of the different immunologic reactions in the liver and it ability to compensate for damage. Although it is not easy to define the histological features that help diagnosis because of its rarity, a few histologic features such as portal eosinophilia with eosinophilic endothelialitis have been reported as useful for diagnosis of acute AMR in presensitized patients. C4d staining is not a good indicator of AMR in liver grafts because of its low sensitivity and specificity. AMR is an emerging cause of chronic graft failure, especially in high risk patients having preformed or de novo donor specific alloantibodies (DSA). Some histologic parameters including interface hepatitis, lobular inflammation, portal collagenation, portal venopathy, and sinusoidal fibrosis, have been suggested as chronic AMR to predict graft fibrosis and survival in DSA positive patients. In conclusion, recent studies have resulted in the histological diagnostic criteria of AMR becoming more specific; however, confirmation of AMR still requires strong clinical evidence for alloantibodies.

Keyword

Graft rejection; Liver transplantation; Histology; Complement 4d

MeSH Terms

Collagen
Diagnosis*
Eosinophilia
Eosinophils
Fibrosis
Graft Rejection
Heart
Hepatitis
Humans
Inflammation
Isoantibodies
Kidney
Liver Transplantation
Liver*
Sensitivity and Specificity
Tissue Donors
Transplants
Collagen
Isoantibodies

Figure

• 

  Fig. 1 Histologic findings of acute antibody mediated rejection. (A) Hyperacute rejection revealed confluent hepatic necrosis, sinusoidal congestion and red blood cell plugging (Hematoxylin-Eosin stain, ×200). (B) Acute antibody mediated rejection (AMR) revealed portal eosinophilia and eosinophilic venulitis, aggregates of eosinophils under subendothelial space and in capillary lumen (arrows indicates eosinophils, Hematoxylin-Eosin stain, ×400). (C) Immunohistochemistry for C4d in hyperacute rejection revealed positive stain in portal venules (arrows, ×400). (D) Immunohistochemistry for C4d in AMR revealed positive stain in portal venules and sinusoid (arrows, ×400).

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