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

• DOI: 10.1111/hepr.12924
• Publication Date: 2017-06-19T06:03:11Z
• Authors: 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
• Keywords: Isoantibodies; Etiology

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