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<p>The incidence of antibody-mediated rejection (AMR) following ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) has decreased since the introduction of rituximab. However, the prognosis is extremely poor once AMR develops. Therefore, perioperative monitoring of anti-blood&#xa0;type antibody titers is important. Here, we report a rare case of ABO-I LDLT that developed AMR without elevated anti-blood&#xa0;type antibody titers. The patient was a 65-year-old man (Type A +) who underwent ABO-I LDLT for alcoholic cirrhosis using a liver right-lobe graft from a 60-year-old woman (Type B +). Rituximab was administered preoperatively. On postoperative day (POD) 5, the portal blood flow decreased drastically. Liver biopsy showed AMR, although there was no increase in the anti-blood&#xa0;type B antibody titer. This resulted in a delay in the diagnosis and treatment of AMR. Steroid pulse therapy, high-dose intravenous immunoglobulin, and plasma exchange were immediately performed. However, the patient developed prolonged graft dysfunction and died on POD40. The pathological findings at autopsy revealed a diagnosis of hepatic veno-occlusive disease. This case suggests that a method other than anti-blood&#xa0;type antibodies should be developed for early diagnosis of AMR.</p>

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Antibody-mediated rejection without elevated anti-blood type antibody after ABO-incompatible living donor liver transplantation: a case report

  • 期刊论文

  • 发表日期：

    2025年7月29日

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  • Junichi Ogawa,
  • Shinichi Nakanuma,
  • Ryosuke Gabata,
  • Mitsuyoshi Okazaki,
  • Akihiro Seki,
  • Satoshi Takada,
  • Isamu Makino,
  • Hiroko Ikeda,
  • Takumi Taniguchi,
  • Shintaro Yagi

摘要

The incidence of antibody-mediated rejection (AMR) following ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) has decreased since the introduction of rituximab. However, the prognosis is extremely poor once AMR develops. Therefore, perioperative monitoring of anti-blood type antibody titers is important. Here, we report a rare case of ABO-I LDLT that developed AMR without elevated anti-blood type antibody titers. The patient was a 65-year-old man (Type A +) who underwent ABO-I LDLT for alcoholic cirrhosis using a liver right-lobe graft from a 60-year-old woman (Type B +). Rituximab was administered preoperatively. On postoperative day (POD) 5, the portal blood flow decreased drastically. Liver biopsy showed AMR, although there was no increase in the anti-blood type B antibody titer. This resulted in a delay in the diagnosis and treatment of AMR. Steroid pulse therapy, high-dose intravenous immunoglobulin, and plasma exchange were immediately performed. However, the patient developed prolonged graft dysfunction and died on POD40. The pathological findings at autopsy revealed a diagnosis of hepatic veno-occlusive disease. This case suggests that a method other than anti-blood type antibodies should be developed for early diagnosis of AMR.