Acute Antibody-mediated Rejection Coexisting With T Cell–mediated Rejection in Pediatric ABO-incompatible Transplantation

Yusuke Yanagi, MD, PhD; Seisuke Sakamoto, MD, PhD; Masaki Yamada, MD, PhD; Koutaro Mimori, MD; Toshimasa Nakao, MD, PhD; Tasuku Kodama, MD, PhD; Hajime Uchida, MD, PhD; Seiichi Shimizu, MD, PhD; Akinari Fukuda, MD, PhD; Noriyuki Nakano, MD, PhD; Chiduko Haga, MD, PhD; Takako Yoshioka, MD, PhD; Mureo Kasahara, MD, PhD

doi:10.1097/TXD.0000000000001359

Transplantation Direct (Sep 2022)

Acute Antibody-mediated Rejection Coexisting With T Cell–mediated Rejection in Pediatric ABO-incompatible Transplantation

Yusuke Yanagi, MD, PhD,
Seisuke Sakamoto, MD, PhD,
Masaki Yamada, MD, PhD,
Koutaro Mimori, MD,
Toshimasa Nakao, MD, PhD,
Tasuku Kodama, MD, PhD,
Hajime Uchida, MD, PhD,
Seiichi Shimizu, MD, PhD,
Akinari Fukuda, MD, PhD,
Noriyuki Nakano, MD, PhD,
Chiduko Haga, MD, PhD,
Takako Yoshioka, MD, PhD,
Mureo Kasahara, MD, PhD

Affiliations

Yusuke Yanagi, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Seisuke Sakamoto, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Masaki Yamada, MD, PhD: 2 Division for Advanced Medicine for Viral Infection, National Center for Child Health and Development, Tokyo, Japan.
Koutaro Mimori, MD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Toshimasa Nakao, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Tasuku Kodama, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Hajime Uchida, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Seiichi Shimizu, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Akinari Fukuda, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.
Noriyuki Nakano, MD, PhD: 3 Department of Pathology, National Center for Child Health and Development, Tokyo, Japan.
Chiduko Haga, MD, PhD: 3 Department of Pathology, National Center for Child Health and Development, Tokyo, Japan.
Takako Yoshioka, MD, PhD: 3 Department of Pathology, National Center for Child Health and Development, Tokyo, Japan.
Mureo Kasahara, MD, PhD: 1 Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan.

DOI: https://doi.org/10.1097/TXD.0000000000001359
Journal volume & issue: Vol. 8, no. 9
p. e1359

Abstract

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Background. The management and outcome of ABO-incompatible (ABO-I) liver transplantation (LT) has been improving over the past few decades. Recently, the introduction of a pathological evaluation of acute antibody-mediated rejection (AMR) for liver allograft has provided a new recognition of allograft rejection in LT. Methods. One hundred and one pediatric ABO-I LTs performed in our institute were retrospectively analyzed. We assessed the clinical manifestations, diagnosis, and treatment of acute AMR, focusing on the recipient age and pathological findings. Results. Twelve cases (11.9%) of acute AMR related to ABO-I were observed. Nine cases developed mixed T cell–mediated rejection (TCMR)/AMR. These consisted of 6 patients in the younger age group for whom the preconditioning treatment was not indicated and 4 patients in the older age group to whom rituximab was administered as planned. Two patients in the older age group to whom preoperative rituximab was not administered as planned developed isolated AMR. Acute AMR in the older group required plasma exchange for treatment, regardless of the coexistence of TCMR. In contrast, those in the younger group were successfully treated by intravenous methylprednisolone pulse and intravenous immunoglobulin without plasma exchange, accounting for mild immune reaction. Conclusions. Acute ABO-I AMR can develop simultaneously with TCMR, even in young patients with a compromised humoral immune response following ABO-I LT. Establishing the accurate diagnosis of AMR with a pathological examination, including component 4d staining, is crucial for optimizing treatment.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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