Clinicopathologic Characteristics of Late Acute Antibody-mediated Rejection in Pediatric Liver Transplantation
| Autor: | Nick Shillingford, Shengmei Zhou, Danny Thomas, Yuri Genyk, Nishant Tiwari, Tania Mitsinikos, Julie Huss Bawab, David M. Parham, Carly Weaver, Larry Wang, Mikako Warren, Juliet Emamaullee |
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| Rok vydání: | 2021 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty Time Factors medicine.medical_treatment 030230 surgery Liver transplantation Risk Assessment Gastroenterology ABO Blood-Group System 03 medical and health sciences 0302 clinical medicine Refractory HLA Antigens Isoantibodies Risk Factors Internal medicine Biopsy medicine Humans Arteritis Child Retrospective Studies Transplantation medicine.diagnostic_test Bile duct business.industry Incidence Graft Survival Age Factors Infant medicine.disease Liver Transplantation Treatment Outcome medicine.anatomical_structure Child Preschool Histocompatibility Hepatocyte necrosis Antibody mediated rejection Female 030211 gastroenterology & hepatology Central veins business Biomarkers |
| Zdroj: | Transplantation. 105:2045-2053 |
| ISSN: | 0041-1337 |
| DOI: | 10.1097/tp.0000000000003469 |
| Popis: | Background An early and accurate diagnosis of liver antibody-mediated rejection (AMR) followed by timely intervention is important for clinical management but remains challenging. The aim of this study was to assess the clinicopathologic characteristics and outcomes of late acute AMR in pediatric liver transplantation recipients. Methods We performed a retrospective review of 739 ABO-identical/compatible allograft liver biopsies from 199 pediatric transplantation recipients. Results Based on Banff 2016 AMR criteria, 3 recipients fulfilled the criteria for definite for late acute AMR, 2 met the criteria for suspicious for AMR, and 2 were indeterminate for AMR. We further assessed the clinicopathologic characteristics of these 7 patients. All 7 patients had at least 1 biopsy with a histopathologic pattern compatible with acute AMR. Additionally, we observed accompanied moderately to markedly dilated portal/central veins and endothelialitis disproportionate to the degree of bile duct injury in all 7 patients; periportal/perivenular hepatocyte necrosis was seen in 6/7 patients; and arteritis was seen in 3/7 patients. In each case, microvascular C4d deposition was present in at least 1 biopsy. Posttransplant donor specific anti-HLA antibodies were detected in 5 patients. Two of 7 patients were retransplanted, and 2 died after developing refractory AMR. The remaining 5 patients were alive with stable graft function at a median follow-up of 4.1 years. Conclusions Our data suggest that acute AMR in pediatric liver grafts is rare, can develop late, and may be associated with graft loss or patient death. The recurrent histopathologic findings of moderately to markedly dilated portal/central veins and endothelialitis disproportionate to the degree of bile duct injury are features that appear unique to pediatric acute AMR of liver grafts. |
| Databáze: | OpenAIRE |
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