Diagnosis and therapy of antibody-mediated rejections in pediatrics after living donor liver transplantation / 中华器官移植杂志

ABSTRACT

Objective To summary the diagnosis and therapy of antibody-mediated rejection (AMR) caused by donor specific antibody (DSA) in pediatrics after living donor liver transplantation.Methods The clinical data of total 4 pediatric recipients with biliary atresia after liver transplantation were retrospectively analyzed.Liver biopsy was performed and HLA antibodies were detected by Luminex.The abnormal graft function was found.Results The concentrations of immunosuppressant were very low pre-AMR-diagnosed.DSA was detected in total 4 patients with the most DSA at HLA-Ⅱ antibodies.Staining of C4d was positive in liver biopsies in 3 of 4 recipients.The patients were gvien plasmapheresis,intravenous immunoglobulin,mycophenolate mofetil and rituximab postdiagnosis.However,only 1 patient was cured with normal graft function and negative DSA.The rest of patients received re-transplantation because of ineffective treatment and showed a well graft function during the follow-up period.Conclusion AMR induced by DSA was rare complaint after pediatric liver transplantation,with serious consequence and poor prognosis.AMR in some patients can be cured by conservative therapies as being diagnosed definitely.However,re-transplantation was oneof the valid therapies to AMR.