Chronic Antibody-Mediated Liver Rejection: More than Meets the Eye
| Autor: | Esther Moreno-Moreno, Israel Nieto-Gañán, Ignacio Iturrieta-Zuazo, Claudia Geraldine Rita, Nieves Alonso-Alarcón, José Luis Castañer-Alabau, Rubén Ballester-González |
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| Rok vydání: | 2021 |
| Předmět: |
Cirrhosis
biology business.industry medicine.medical_treatment Donor specific antibodies Human leukocyte antigen 030230 surgery Liver transplantation medicine.disease 03 medical and health sciences 0302 clinical medicine Antigen Liver enzyme Immunology biology.protein Medicine Immunohistochemistry 030211 gastroenterology & hepatology Antibody business |
| Zdroj: | Transplantology. 2:1-7 |
| ISSN: | 2673-3943 |
| Popis: | Understanding the role of donor-specific antibodies (DSAs) in liver transplantation remains an investigative priority. Acute and chronic rejection associated with DSAs have been described. However, most transplant protocols did not consider the presence of DSAs at the moment of liver transplantation (LTx) or for the follow-up. A 65-year-old man received an ABO-compatible LTx for cirrhosis. Ten years after the LTx, he presented with a progressive elevation of liver enzymes and bilirubin. The single antigen Luminex bead assay showed the presence of DSAs against several DQ2, DQ7, and DQ8 alleles. The patient received several desensitization treatments regarding the persistence of DSAs. The anatomopathological study confirms chronic rejection. Although in this case the immunohistochemical deposits of C4d were negative, the data revealed morphological criteria of chronic graft injury and DSAs’ incompatibilities explained by structural analysis. These data support an antibody-mediated rejection (AMR). It could be reasonable to establish a protocol for human leukocyte antigen (HLA) typing of every LTx donor and recipient as well as a periodic follow-up to assess the presence of DSAs. This will make it possible to carry out studies of donor–recipient incompatibility and to confirm the existence of probable cases of AMR. |
| Databáze: | OpenAIRE |
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