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Yamada Y, Hoshino K, Mori T, et al. Successful living donor liver retransplantation for graft failure within 7 days due to acute de novo donor-specific anti-human leukocyte antigen antibody-mediated rejection. Hepatol Res. 2017;48(3):E360-E366doi: 10.1111/hepr.12924.
Yamada, Y., Hoshino, K., Mori, T., Kawaida, M., Abe, K., Ishihama, H., Shimizu, T., Takahashi, N., Matsubara, K., Hibi, T., Abe, Y., Yagi, H., Shimojima, N., Shinoda, M., Kitago, M., Obara, H., Fuchimoto, Y., Kameyama, K., Kitagawa, Y., & Kuroda, T. (2018). Successful living donor liver retransplantation for graft failure within 7 days due to acute de novo donor-specific anti-human leukocyte antigen antibody-mediated rejection. Hepatology research : the official journal of the Japan Society of Hepatology, 48(3), E360-E366. https://doi.org/10.1111/hepr.12924
Yamada, Yohei, et al. "Successful living donor liver retransplantation for graft failure within 7 days due to acute de novo donor-specific anti-human leukocyte antigen antibody-mediated rejection." Hepatology research : the official journal of the Japan Society of Hepatology vol. 48,3 (2018): E360-E366. doi: https://doi.org/10.1111/hepr.12924
Yamada Y, Hoshino K, Mori T, Kawaida M, Abe K, Ishihama H, Shimizu T, Takahashi N, Matsubara K, Hibi T, Abe Y, Yagi H, Shimojima N, Shinoda M, Kitago M, Obara H, Fuchimoto Y, Kameyama K, Kitagawa Y, Kuroda T. Successful living donor liver retransplantation for graft failure within 7 days due to acute de novo donor-specific anti-human leukocyte antigen antibody-mediated rejection. Hepatol Res. 2018 Feb;48(3):E360-E366. doi: 10.1111/hepr.12924. Epub 2017 Aug 16. PMID: 28626871.
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Hepatol Res. 2018 Feb;48(3):E360-E366. doi: 10.1111/hepr.12924. Epub 2017 Aug 16.

Successful living donor liver retransplantation for graft failure within 7 days due to acute de novo donor-specific anti-human leukocyte antigen antibody-mediated rejection.

Hepatology research : the official journal of the Japan Society of Hepatology

Yohei Yamada, Ken Hoshino, Teisaburo Mori, Miho Kawaida, Kiyotomo Abe, Hideo Ishihama, Takahiro Shimizu, Nobuhiro Takahashi, Kentaro Matsubara, Taizo Hibi, Yuta Abe, Hiroshi Yagi, Naoki Shimojima, Masahiro Shinoda, Minoru Kitago, Hideaki Obara, Yasushi Fuchimoto, Kaori Kameyama, Yuko Kitagawa, Tatsuo Kuroda

Affiliations

  1. Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
  2. Department of Pathology, Keio University School of Medicine, Tokyo, Japan.
  3. Department of Surgery, Keio University School of Medicine, Tokyo, Japan.

PMID: 28626871 DOI: 10.1111/hepr.12924

Abstract

Growing evidence suggests a relationship between antibody-mediated rejection (AMR) and early graft failure due to a previously unknown etiology in liver transplantation (LTx). We herein report a 3-year-old boy who developed rapid graft failure due to de novo donor-specific antibody (DSA)-driven AMR a week after living donor LTx, requiring a second transplant on the 10th day after the first LTx. The pathology of the first graft showed massive necrosis in zone 3 along with positive C4d and inflammatory cell infiltrates in portal areas. The mean fluorescence intensity against human leukocyte antigen (HLA)-DR15, which was possessed by both the first and the second donor, peaked at 12 945 on the day before the second LTx. Antithymocyte globulin, plasma exchange along with i.v. immunoglobulin, rituximab, and the local infusion of prostaglandin E1, steroids, and Mesilate gabexate through a portal catheter were provided to save the second graft. To our knowledge, this is the first report to show a clear association between de novo DSA and acute AMR within 7 days of a LTx. Furthermore, we successfully rescued the recipient with a second graft despite possessing the same targeted HLA. The rapid decision to carry out retransplantation and specific strategies overcoming AMR were crucial to achieving success in this case of immunologically high-risk LTx.

© 2017 The Japan Society of Hepatology.

Keywords: desensitization; donor-specific antibody; liver transplantation; retransplantation; seventh day syndrome

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