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Recurrent Idiopathic Liver Allograft Failure.
Thomas D Schiano1,2, Sander Florman1, M Isabel Fiel3
1The Recanati-Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
American Journal of Clinical Pathology
|May 30, 2019
Summary
Recurrent liver allograft failure can stem from antibody-mediated rejection (AMR), often presenting with varied histology. Early recognition of AMR is crucial for timely intervention in transplant patients.
Area of Science:
- Transplantation immunology
- Gastroenterology
- Pathology
Background:
- Idiopathic recurrent liver allograft failure and refractory rejection necessitate retransplants.
- The frequency and causes of this immune dysfunction remain poorly understood.
Observation:
- A case study details a patient requiring three liver retransplants over 20 years for recurrent allograft failure.
- Analysis of biopsy specimens revealed antibody-mediated rejection (AMR) as a primary factor from the beginning.
- A database review was performed to estimate the frequency of AMR.
Findings:
- Antibody-mediated rejection (AMR) can manifest with diverse histological findings.
- Elevated donor-specific antibody titers are associated with AMR.
Implications:
- Recurrent liver allograft failure is often caused by a combination of acute cellular rejection and AMR.
- Recognizing the varied histological presentations of AMR is critical for prompt diagnosis and treatment.
- This case underscores the importance of clinical suspicion for AMR in challenging rejection cases.
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