MENG HSİNG HO, Sİ YUAN WU, KUANG WEN OU, TİNG FU SU, CHUNG BAO HSİEH
Experimental and Clinical Transplantation - 2018;16(2):222-226
Antibody-mediated rejection after liver transplant, especially when the donor is not a direct relative; it is associated with additional inconvenience for patients. We encountered a case in which antibody-mediated rejection because of de novo donor specific antibodies against donor human leukocyte antigen developed 6 months after ABO-compatible living-donor liver transplant and was treated with retransplant. A 38-yearold man with hepatitis B virus-related hepatocellular carcinoma underwent living-donor liver transplant with a graft from his wife. Six months later, he experienced fatigue and jaundice. Liver biopsy revealed C4d deposits, and histologic examination showed an antibody-mediated rejection pattern. We re-evaluated recipient-donor human leukocyte antigen matching and tested the patient’s blood for antihuman leukocyte antigen donor-specific antibodies against donor human leukocyte antigen. De novo auto antibodies against human leukocyte antigen-DQ6 were identified by Luminex single antigen beads. Because exhausting all treatment options, a rescue second living-donor liver transplant was planned with the patient’s stepdaughter as the donor. Pretransplant human leukocyte antigen matching was performed, and the patient was discharged without event. Two months later, hyper - bilirubinemia was noted, and a residual common bile duct from the first donor with chronic fibrosis and stricture was strongly suspected. Redo hepaticoje - junostomy was successfully performed, with no problems during 1-years’ follow-up. Thus, liver retransplant could be a rescue treatment for antibodymediated rejection complicated with hepatic failure.
