C4d immunostaining in acute humoral rejection after ABO blood group-incompatible liver transplantation

✍ Scribed by Ulf P. Neuman; Peter Neuhaus

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 54 KB
• Volume: 12
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.20658

✦ Synopsis

Clinical experiences with ABO blood group-incompatible hepatic grafts have shown that, unlike kidney and heart grafts, the liver is more resistant to antibodymediated hyperacute rejection although cases of hyperacute rejections have been reported. Nevertheless, liver transplantation across the ABO blood barrier has been associated with a significantly higher rate of graft failure and patient mortality. 1 Especially in large series, the decreased survival figures in ABO-incompatible liver transplantation became evident. This survival disadvantage was not only due to emergency conditions, but also due to immunological damage such as hyperacute rejections, vascular complications, and biliary injury. To improve graft survival among ABO-incompatible grafts, several approaches including quadruple immunosuppression, pre-and posttransplantation plasmapheresis, and splenectomy were tested. 2 However, the long-term risk of postsplenectomy sepsis, especially in immunosuppressed patients, makes the routine splenectomy undesirable. Furthermore, the efficacy of plasmapheresis in preventing humoral-mediated rejection remains questionable, since it has been reported that a decline of up to 44% in isoagglutinin titers might lead to infectious disorders, bleeding diathesis, and viral transmission. After the clinical introduction of monoclonal anti-CD 20 antibody, the optimal management of ABO-incompatible transplantation does however still require further investigation. Another major problem of ABO-incompatible liver transplantation is the lack of markers and predictors for occurrence of humoral rejection.