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Case Report

J Korean Soc Transplant 2018; 32(4): 108-112

Published online December 31, 2018

https://doi.org/10.4285/jkstn.2018.32.4.108

© The Korean Society for Transplantation

Donor Specific Antibody Negative Antibody-Mediated Rejection after ABO Incompatible Liver Transplantation

Boram Lee, M.D.1, Soomin Ahn, M.D.2, Haeryoung Kim, Ph.D.3, Ho-Seong Han, Ph.D.1,
Yoo-Seok Yoon, Ph.D.1, Jai Young Cho, Ph.D.1 and Young Rok Choi, M.D.1

Departments of Surgery1 and Pathology2, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine3, Seoul, Korea

Correspondence to: Young Rok Choi
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea
Tel: 82-31-787-7111, Fax: 82-31-787-4055
E-mail: choiyoungrok@gmail.com

Received: July 6, 2018; Revised: September 6, 2018; Accepted: September 13, 2018

Abstract

Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.

Keywords: Liver transplantation, Antibody-dependent cell cytotoxicity, Rejection, Living donors, HLA antigens