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Updated: Jul 19, 2026
11:25
Heterotopic Auxiliary Whole Liver Rat Transplant Model Utilizing a Hepaticoureterostomy for Allograft Rejection Studies
Published on: March 8, 2024
Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation
R Watson1, T Kozlowski, V Nickeleit
1Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Summary
Antibody-mediated rejection (AMR) can cause liver graft failure even in ABO compatible transplants. This rejection shows distinct C4d staining and can occur without acute cellular rejection.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Nephrology
Background:
- Antibody-mediated rejection (AMR) is a known complication in ABO incompatible and xenotransplantation.
- Its role in ABO compatible liver transplantation remains controversial.
Observation:
- A case of ABO compatible liver transplantation is presented with clinical, serological, and histological signs of AMR.
- This occurred without evidence of concurrent acute cellular rejection.
Findings:
- High titers of donor-specific antibodies caused graft injury, including hepatocyte necrosis and fibrosis.
- Immunofluorescence revealed diffuse linear C4d deposits along sinusoids and central veins.
- Despite aggressive treatment, AMR led to graft failure.
Implications:
- This case provides evidence that AMR can cause significant ABO compatible liver graft injury independently of acute cellular rejection.
- Distinct histologic changes, including C4d deposition, characterize AMR in liver transplantation.
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