Robinson TJ, Hendele JB, Gimferrer I, Leca N, Biggins SW, Reyes JD, Sibulesky L. Acute liver failure secondary to acute antibody mediated rejection after compatible liver transplant: A case report. World J Hepatol 2022; 14(1): 287-294 [PMID: 35126855 DOI: 10.4254/wjh.v14.i1.287]
Corresponding Author of This Article
Lena Sibulesky, MD, Associate Professor, Surgeon, Department of Surgery, University of Washington Medical Center, UWMC 1959 NE Pacific St, Box 356410 Seattle, Seattle, WA 98195, United States. lenasi@uw.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jan 27, 2022; 14(1): 287-294 Published online Jan 27, 2022. doi: 10.4254/wjh.v14.i1.287
Acute liver failure secondary to acute antibody mediated rejection after compatible liver transplant: A case report
Todd J Robinson, James B Hendele, Idoia Gimferrer, Nicolae Leca, Scott W Biggins, Jorge D Reyes, Lena Sibulesky
Todd J Robinson, Department of Surgery, Virginia Mason, Seattle, WA 98101, United States
James B Hendele, Jorge D Reyes, Lena Sibulesky, Department of Surgery, University of Washington Medical Center, Seattle, WA 98195, United States
Idoia Gimferrer, Bloodworks Northwest, Seattle, WA 98104, United States
Nicolae Leca, Department of Nephrology, University of Washington Medical Center, Seattle, WA 98195, United States
Scott W Biggins, Department of Gastroenterology and Hepatology, University of Washington Medical Center, Seattle, WA 98195, United States
Author contributions: Robinson TJ, Hendele JB, and Sibulesky L reviewed the literature, interpreted data, and contributed to manuscript drafting; Gimferrer I, Leca N, Biggins SW, and Reyes JD interpreted data and were responsible for the revision of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lena Sibulesky, MD, Associate Professor, Surgeon, Department of Surgery, University of Washington Medical Center, UWMC 1959 NE Pacific St, Box 356410 Seattle, Seattle, WA 98195, United States. lenasi@uw.edu
Received: October 8, 2021 Peer-review started: October 8, 2021 First decision: November 17, 2021 Revised: November 23, 2021 Accepted: December 31, 2021 Article in press: December 31, 2021 Published online: January 27, 2022 Processing time: 104 Days and 11.9 Hours
Core Tip
Core Tip: The liver has traditionally been regarded as resistant to antibody-mediated rejection (AMR). AMR in liver transplants is a field in its infancy compared to kidney and lung transplants. We present a case of a 56 year-old woman with alpha-1-antitrypsin disease who underwent ABO compatible liver transplant. The flow cytometric crossmatches were noted to be positive for T and B lymphocytes. After initial posttransplant recovery she progressively developed acute liver failure with evidence of antibody mediated rejection with portal inflammation, bile duct injury, endothelitis, and extensive centrizonal necrosis, and C4d staining on allograft biopsy and elevated donor-specific antibodies. Despite various interventions including plasmapheresis and immunomodulating therapy, she required retranpslantation.
