TABLE 1.
Correlation of serum DSA with histology (gray shows de novo DSA)
| No. | Preformed DSA | DSA test days after SLKT | Post-DSA | Bx-days after SLKT | C4d kidney | Kidney path summary | C4d liver | Liver path summarya | Outcome | ||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Class I | Class II | Class I | Class II | ||||||||
| 1 | 0 | 0 | 65 | 0 | 9000 | 65, 66 | Focal ptc positivity | Mild acute AMR (g1-2, i1, t0, v0, ptc1); mild to moderate chronic changes (cg0, ci1, ct1, cv2) likely related to donor disease | Diffuse portal microvascular endothelial cell positivity; negative LSEC; focal KC cytoplasmic positivity | Low-grade acute AMR (i3, h2) with prominent KC hypertrophy with KC C4d staining | Renal allograft failure 3. 5 mo; biliary strictures developed; death 9 y post-SLKT |
| 2 | 6700 | 0 | 13 | 0 | 0 | 15, 13 | Diffuse ptc positivity | Mild acute AMR (g1-2, i1, t0, v0, ptc2); no chronic changes (cg0, ci0, ct0, cv0) likely related to donor disease | Diffuse portal microvascular endothelial cell positivity; negative LSEC | Low-grade AMR (i3, h2); KC less prominent than case no. 1 | Death 8 y post-SLKT from liver allograft failure |
| 3a | 23 000b | 25 000 | 54 | 10, 54 | Diffuse ptc positivity | Mild AMR (g1, i1, t0, ptc1); no chronic changes (cg0, ci0, ct0, cv0, ah0) | Diffuse portal microvascular and central vein endothelial cell positivity; negative LSEC | Mixed TCMR and AMR (i3, h2) with central perivenular and sclerosing central vein lesions in regions of prominent C4d deposition | Renal allograft failure 2. 5 y posttransplant: HAT and death 11 y post-SLKT | ||
| 3b | 301 | 15 000 | 18 000 | 301 346 | Minimal ptc positivity | Suspicious for AMR (g0, I1, t0, v0, ptc1); mild chronic changes (cg0, ci1, ct1, cvo, ah0) | Negative | Negative for TCMR and AMR with intact architecture with periportal-shunt-type vessel | |||
| 4a | 13 000 | 0 | 5 | NA | NA | 8, 5 | Negative | No specific histopathologic changes (go, i0, t0, v0, ptc0); no chronic changes (cg0, ci0, ct0, cv0, ah0) | Minimal microvascular endothelial cell positivity | Minimal changes (i1, h0) with prominent KC hypertrophy | GFR at 3 y 36 mL/min; follow-up liver biopsy showed plasma cell rich TCMR and chronic AMR; death from a GI bleed 4. 5 y post-SLKT |
| 4b | 74, 134 | Minimal ptc positivity | Minimal histopathologic changes/suspicious for minimal AMR (g0, i1, t0, vo, ptc1); mild chronic changes (cg0, ci1, ct1, cv0, ah1) | Minimal portal capillary and LSEC positivity | Plasma cell-rich TCMR with interface activity and central perivenulitis/probably chronic AMR (i2, h2) | ||||||
aScoring per Banff 2016 criteria.
bC1q positive DSA.
AMR, antibody-mediated rejection; Bx, biopsy; DSA, donor specific alloantibodies; GFR, glomerular filtration rate; GI, gastrointestinal; HAT, hepatic artery thrombosis; KC, Kupffer cell; LSEC, liver sinusoidal endothelial cell; NA, not available; ptc, peritubular capillary; SLKT, simultaneous liver-kidney transplant; TCMR, T-cell mediated rejection.