Clinical Perspective of Acute Humoral Rejection After Blood Type-Compatible Liver Transplantation

Chan, Kun‐Ming; Lee, Ching-Sung; Wu, Tsung‐Han; Lee, Chen-Fang; Chen, Tse–Ching; Lee, Wei‐Chen

doi:10.1097/tp.0b013e318208138c

Cited by 35 publications

(30 citation statements)

References 14 publications

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“…These strictures were successfully managed by endoscopic or percutaneous biliary dilatation. There were also three hospital mortalities in this group: one died 7 days after LT due to primary graft nonfunction; one died 17 days after LT, most probably due to acute rejection (15); and the third recipient died of postoperative infection 3.5 months after LT. The Kaplan‐Meier 1‐year survival rate of patients undergoing LAL‐LT was 71.4% (Figure 2).…”

Section: Resultsmentioning

confidence: 86%

“Left at Right” Adult Liver Transplantation: The Feasibility of Heterotopic Implantation of Left Liver Graft

Chan

Eldeen

Lee

et al. 2012

American Journal of Transplantation

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†Both authors contributed equally to this work. Left liver grafts have been widely utilized in adult liver transplantation (LT) and yielded acceptable results.However, the conventional orthotopic implantation of a left liver graft imposes the potential risk of perioperative vascular complications. We report herein an alternative modified technique for adult left liver LT and evaluate its feasibility in LT. In this study, 10 recipients had their left liver graft rotated 180• , and heterotopically implanted at the right subphrenic space, which we termed "left at right" liver transplantation (LAR-LT). The sequence of vascular and biliary reconstruction was performed as standard techniques, and no perioperative vascular complications related to LAR-LT were encountered. There were two mortalities in this series, one due to a small-for-size graft dysfunction and the other due to postoperative internal hemorrhage. Two recipients had biliary strictures that were successfully managed by percutaneous biliary dilatation and Roux-en-Y hepaticojejunostomy. The clinical characteristics and outcomes of patients undergoing LAR-LT were also compared with patients undergoing conventional orthotopic left liver LT (n = 14). Although the results showed no significant difference between the two groups, according to our experience, the satisfactory outcome and easier technical reconstruction suggest that the LAR-LT modification could be a feasible alternative to left liver LT.

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Section: Resultsmentioning

confidence: 86%

“Left at Right” Adult Liver Transplantation: The Feasibility of Heterotopic Implantation of Left Liver Graft

Chan

Eldeen

Lee

et al. 2012

American Journal of Transplantation

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“…The ability to perform a liver transplant without hyperacute rejection despite a positive crossmatch contributes to the belief that liver a lografts are “resistant” to DSA (12). However, in the last decades, a few cases of acute AMR after ABO-compatible liver transplant have been reported (2–4,13). Furthermore, chronic rejection in liver transplantation has been associated with DSA, as it is in other solid organ transplants (7).…”

Section: Introductionmentioning

confidence: 99%

Bortezomib for Acute Antibody-Mediated Rejection in Liver Transplantation

Paterno

Shiller

Tillery

et al. 2012

American Journal of Transplantation

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Antibody-mediated rejection (AMR) is an uncommon, but challenging type of rejection after solid organ transplantation. We review three cases of AMR in ABO- compatible liver transplant recipients. These cases were characterized by severe acute rejection resistant to steroids and antithymocyte globulin, histologic evidence of plasma cell infiltrates, C4d positivity and high serum anti-HLA donor-specific antibodies. All three patients were treated with bortezomib, a proteasome inhibitor effective in depleting plasma cells. After treatment, all patients had improved or normal liver function tests, resolution of C4d deposition and significant decline in their HLA donor-specific antibodies.

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“…83 However, several case reports in ABO blood group-compatible liver transplants have been reported with poor graft outcome. [84][85][86] These data suggest that in steroid-resistant patients with acute rejection, measurement of DSA titers can lead to the identification of AMR and trigger appropriate treatment. 87 If a promising biomarker has been identified, it should be rapidly validated in large multicenter trials that are able to recruit a sufficient amount of patients and events to achieve enough power.…”

Section: Discussionmentioning

confidence: 90%

“…Recent work observed DSA in 22.2% of a large prospective liver transplant cohort, without affecting rejection rates . However, several case reports in ABO blood group‐compatible liver transplants have been reported with poor graft outcome . These data suggest that in steroid‐resistant patients with acute rejection, measurement of DSA titers can lead to the identification of AMR and trigger appropriate treatment …”

Section: Discussionmentioning

confidence: 99%

Biomarkers for the diagnosis of acute cellular rejection in liver transplant recipients: A review

Verhelst

Troisi

Colle

et al. 2012

Hepatology Research

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The gold standard for the diagnosis of acute cellular rejection (ACR) is a liver biopsy. The quest for an alternative noninvasive biomarkers has been long and is ongoing. However, an efficient and useful biomarker has not been developed yet. In this manuscript, we review all possible candidate biomarkers that have been studied in recent years, starting with cytokines and ending with an overview of different newly discovered "omics". Promising paths are being explored but a valid non-invasive biomarker has not been discovered yet.

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Clinical Perspective of Acute Humoral Rejection After Blood Type-Compatible Liver Transplantation

Cited by 35 publications

References 14 publications

“Left at Right” Adult Liver Transplantation: The Feasibility of Heterotopic Implantation of Left Liver Graft

“Left at Right” Adult Liver Transplantation: The Feasibility of Heterotopic Implantation of Left Liver Graft

Bortezomib for Acute Antibody-Mediated Rejection in Liver Transplantation

Biomarkers for the diagnosis of acute cellular rejection in liver transplant recipients: A review

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