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. 1988 Sep;132(3):489–502.

Antibody-Mediated Rejection of Human Orthotopic Liver Allografts

A Study of Liver Transplantation Across ABO Blood Group Barriers

A Jake Demetris, Ron Jaffe, A Tzakis, Glenn Ramsey, S Todo, Steven Belle, Carlos Esquivel, Ron Shapiro, Bernd Markus, Elizabeth Mroczek, D H Van Thiel, Greg Sysyn, Robert Gordon, Leonard Makowka, Tom Starzl
PMCID: PMC1880751  PMID: 3046369

Abstract

A clinicopathologic analysis of liver transplantation across major ABO blood group barriers was carried out 1) to determine if antibody-mediated (humoral) rejection was a cause of graft failure and if humoral rejection can be identified, 2) to propose criteria for establishing the diagnosis, and 3) to describe the clinical and pathologic features of humoral rejection. A total of 51 (24 primary) ABO-incompatible (ABO-I) liver grafts were transplanted into 49 recipients. There was a 46% graft failure rate during the first 30 days for primary ABO-I grafts compared with an 11% graft failure rate for primary ABO compatible (ABO-C), crossmatch negative, age, sex and priority-matched control patients (P < 0.02). A similarly high early graft failure rate (60%) was seen for nonprimary ABO-I grafts during the first 30 days. Clinically, the patients experienced a relentless rise in serum transaminases, hepatic failure, and coagulopathy during the first weeks after transplant. Pathologic examination of ABO-I grafts that failed early demonstrated widespread areas of geographic hemorrhagic necrosis with diffuse intraorgan coagulation. Prominent arterial deposition of antibody and complement components was demonstrated by immunoflourescent staining. Elution studies confirmed the presence of tissue-bound, donor-specific isoagglutinins within the grafts. No such deposition was seen in control cases. These studies confirm that antibody mediated rejection of the liver occurs and allows for the development of criteria for establishing the diagnosis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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