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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
Author(s) -
Yamada Yohei,
Hoshino Ken,
Mori Teisaburo,
Kawaida Miho,
Abe Kiyotomo,
Ishihama Hideo,
Shimizu Takahiro,
Takahashi Nobuhiro,
Matsubara Kentaro,
Hibi Taizo,
Abe Yuta,
Yagi Hiroshi,
Shimojima Naoki,
Shinoda Masahiro,
Kitago Minoru,
Obara Hideaki,
Fuchimoto Yasushi,
Kameyama Kaori,
Kitagawa Yuko,
Kuroda Tatsuo
Publication year - 2018
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12924
Subject(s) - medicine , rituximab , antibody , human leukocyte antigen , liver transplantation , isoantibodies , transplantation , antigen , etiology , immunology , gastroenterology , surgery
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.