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Antibody-mediated rejection of human orthotopic liver allografts. A study of liver transplantation across ABO blood group barriers

Demetris, AJ and Jaffe, R and Tzakis, A and Ramsey, G and Todo, S and Belle, S and Esquivel, C and Shapiro, R and Markus, B and Mroczek, E and Van Thiel, DH and Sysyn, G and Gordon, R and Makowka, L and Starzl, T (1988) Antibody-mediated rejection of human orthotopic liver allografts. A study of liver transplantation across ABO blood group barriers. American Journal of Pathology, 132 (3). 489 - 502. ISSN 0002-9440

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Abstract

A clinicopathologic analysis of liver transplantation across major ABO blood group barriers was carried out 1) to determine if antibody-mediated (humoral) rejection was a cause of graft failure and if humoral rejection can be identified, 2) to propose criteria for establishing the diagnosis, and 3) to describe the clinical and pathologic features of humoral rejection. A total of 51 (24 primary) ABO-incompatible (ABO-I) liver grafts were transplanted into 49 recipients. There was a 46% graft failure rate during the first 30 days for primary ABO-I grafts compared with an 11% graft failure rate for primary ABO compatible (ABO-C), crossmatch negative, age, sex and priority-matched control patients (P < 0.02). A similarly high early graft failure rate (60%) was seen for nonprimary ABO-I grafts during the first 30 days. Clinically, the patients experienced a relentless rise in serum transaminases, hepatic failure, and coagulopathy during the first weeks after transplant. Pathologic examination of ABO-I grafts that failed early demonstrated widespread areas of geographic hemorrhagic necrosis with diffuse intraorgan coagulation. Prominent arterial deposition of antibody and complement components was demonstrated by immunofluorescent staining. Elution studies confirmed the presence of tissue-bound, donor-specific isoagglutinins within the grafts. No such deposition was seen in control cases. These studies confirm that antibody mediated rejection of the liver occurs and allows for the development of criteria for establishing the diagnosis.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Demetris, AJ
Jaffe, R
Tzakis, A
Ramsey, G
Todo, S
Belle, Ssbelle@pitt.eduSBELLE
Esquivel, C
Shapiro, R
Markus, B
Mroczek, E
Van Thiel, DH
Sysyn, G
Gordon, R
Makowka, L
Starzl, Ttes11@pitt.eduTES11
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 1 January 1988
Date Type: Publication
Journal or Publication Title: American Journal of Pathology
Volume: 132
Number: 3
Page Range: 489 - 502
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0002-9440
Other ID: uls-drl:31735062130343, Starzl CV No. 884
Date Deposited: 08 Apr 2010 17:15
Last Modified: 13 Oct 2017 21:58
URI: http://d-scholarship.pitt.edu/id/eprint/4270

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