PMID- 27429102
OWN - NLM
STAT- MEDLINE
DCOM- 20171004
LR  - 20171004
IS  - 1439-7803 (Electronic)
IS  - 0044-2771 (Linking)
VI  - 54
IP  - 7
DP  - 2016 Jul
TI  - Diagnostics and treatment of a severe humoral rejection after liver 
      transplantation: donor-specific antibodies as a still underestimated cause of 
      graft failure.
PG  - 647-52
LID - 10.1055/s-0042-108212 [doi]
AB  - BACKGROUND: Donor-specific antibodies (DSAs) are increasingly being considered a 
      cause of complications after liver transplant (LT). However, neither monitoring 
      of DSAs nor the appropriate therapeutic procedures for humoral graft damage are 
      yet standardized. Here we report a case of DSA-positive humoral rejection after 
      LT that was successfully treated with plasmapheresis and immunoglobulins. 
      METHODS: Human leukocyte antigen (HLA)-specific DSAs were detected by Luminex 
      bead assay. Patient characteristics, laboratory values, and data about the 
      patient's general condition were documented from April 2013 to June 2015. CASE 
      REPORT: Eighteen months after LT, a 54-year-old man experienced severe 
      hepatopathy with rapidly increasing transaminase activity and total bilirubin 
      levels. Histologic findings were inconclusive, demonstrating chronic cholestasis 
      and minimal positive staining for C4 d. However, an analysis for anti-HLA 
      antibodies detected DSAs against HLA class II molecules with high mean 
      fluorescence intensity. The patient underwent 8 courses of plasmapheresis, 
      resulting in sustained amelioration of his condition and decreases in bilirubin 
      levels and transaminase activity. CONCLUSION: De novo DSAs can be responsible for 
      graft failure after LT. Thus, procedures aimed at detecting DSAs are recommended, 
      and regular monitoring of DSAs after LT is important for individualized risk 
      management. Plasmapheresis is an efficient therapeutic procedure for 
      DSA-associated graft failure.
CI  - (c) Georg Thieme Verlag KG Stuttgart . New York.
FAU - Rashidi-Alavijeh, J
AU  - Rashidi-Alavijeh J
AD  - Department of Gastroenterology and Hepatology, University Hospital Essen, 
      University of Duisburg-Essen, Germany.
FAU - Heinold, A
AU  - Heinold A
AD  - Institute for Transfusion Medicine, University Hospital Essen, University of 
      Duisburg-Essen, Germany.
FAU - Willuweit, K
AU  - Willuweit K
AD  - Department of Gastroenterology and Hepatology, University Hospital Essen, 
      University of Duisburg-Essen, Germany.
FAU - Baba, H A
AU  - Baba HA
AD  - Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, 
      Germany.
FAU - Horn, P A
AU  - Horn PA
AD  - Institute for Transfusion Medicine, University Hospital Essen, University of 
      Duisburg-Essen, Germany.
FAU - Paul, A
AU  - Paul A
AD  - Department of General, Visceral and Transplantation Surgery, University Hospital 
      Essen, University of Duisburg-Essen, Germany.
FAU - Witzke, O
AU  - Witzke O
AD  - Department of Infectious Diseases and Department of Nephrology, University 
      Hospital Essen, University of Duisburg-Essen, Germany.
FAU - Gerken, G
AU  - Gerken G
AD  - Department of Gastroenterology and Hepatology, University Hospital Essen, 
      University of Duisburg-Essen, Germany.
FAU - Herzer, K
AU  - Herzer K
AD  - Department of Gastroenterology and Hepatology, University Hospital Essen, 
      University of Duisburg-Essen, Germany.
LA  - eng
PT  - Case Reports
PT  - Journal Article
TT  - Donorspezifische Antikorper als Ursache einer schweren humoralen Rejektion nach 
      Lebertransplantation.
DEP - 20160718
PL  - Germany
TA  - Z Gastroenterol
JT  - Zeitschrift fur Gastroenterologie
JID - 0033370
RN  - 0 (Autoantibodies)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins)
SB  - IM
MH  - Autoantibodies/immunology
MH  - Graft Rejection/etiology/*immunology/*therapy
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Immunity, Humoral/*immunology
MH  - Immunoglobulins/therapeutic use
MH  - Liver Transplantation/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Plasmapheresis/methods
MH  - *Tissue Donors
MH  - Treatment Outcome
EDAT- 2016/07/19 06:00
MHDA- 2017/10/05 06:00
CRDT- 2016/07/19 06:00
PHST- 2016/07/19 06:00 [entrez]
PHST- 2016/07/19 06:00 [pubmed]
PHST- 2017/10/05 06:00 [medline]
AID - 10.1055/s-0042-108212 [doi]
PST - ppublish
SO  - Z Gastroenterol. 2016 Jul;54(7):647-52. doi: 10.1055/s-0042-108212. Epub 2016 Jul 
      18.