Open AccessPROBABLE ANTIBODY-MEDIATED FAILURE OF TWO SEQUENTIAL ABO-COMPATIBLE HEPATIC ALLOGRAFTS IN A SINGLE RECIPIENT
Author(s) -
Lloyd E. Ratner,
D. Phelan,
Elizabeth M. Brunt,
T Mohanakumar,
Douglas W. Hanto
Publication year - 1993
Publication title -
transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.45
H-Index - 204
eISSN - 1534-6080
pISSN - 0041-1337
DOI - 10.1097/00007890-199304000-00025
Subject(s) - abo blood group system , antibody , titer , medicine , liver transplantation , immunology , human leukocyte antigen , transplantation , refractory (planetary science) , isoantibodies , antigen , biology , astrobiology
Two sequential ABO-compatible orthotopic liver allografts failed, despite excellent initial posttransplant function, in a patient with preformed donor-specific alloantibodies. There was no evidence of cell-mediated rejection. Retrospective crossmatching of recipient serum, obtained immediately prior to the first transplant, revealed the presence of lymphocytotoxic antibodies directed against donor class I HLA B17, at a titer of greater than 1:32,768. Similarly, lymphocytotoxic antibodies directed against the second donor's class I HLA A2 phenotype were detected on retrospective crossmatching utilizing both the three-wash Amos technique (TWA-CDC), and the anti-human immunoglobulin augmented technique (AHG-CDC), at a titer of greater than 1:32,768. Anti-class I specific alloantibodies were eluted from both failed liver grafts at titers of 1:256. The hepatic necrosis in zones 3 and 2 that were observed on histologic examination, and the profound refractory consumptive thrombocytopenia subsequent to each transplant may have been the result of antibody-mediated rejection by preformed lymphocytotoxic antibodies. Despite the liver's remarkable capacity to withstand antibody-mediated injury, primary humoral rejection following ABO compatible liver transplantation may occur if extremely high titers of performed allospecific lymphocytotoxic antibodies are present.