https://onlinelibrary.wiley.com/doi/pdf/10.1111/ajt.13909

2016 Comprehensive Update of the Banff Working Group on Liver Allograft Pathology: Introduction of Antibody-Mediated Rejection.

Liver transplantation across ABO blood group barriers

The most important transplantation antigen system in solid organ transplantation is the ABO histo-blood group system. Crossing the ABO barrier in solid organ transplantation is usually not done except for emergency liver transplantations. Early experiences of crossing the ABO barrier in renal transplantation were very disappointing. In the 1970s, clinical trials were started transplanting kidneys of subgroup A2 into blood group O recipients. The tissues of the A2 subgroup expresses reduced amount of A antigens compared to subgroup A1 and the recipients had no special pretreatment and standard immunosuppression. A number of early graft losses were experienced but the trial also resulted in several long time surviving grafts. A few centres have adapted the concept of A2 to non A kidney transplantations with successful results, when the recipient anti-A titres are low or reduced prior to transplantation. In the early 1980s one group successfully transplanted A1 and B kidneys from living related donors across the ABO-barrier using an immunosuppressive protocol consisting of quadruple drugs and splenectomy and this protocol was adapted by a few other groups. In Japan, where cadaver donors are available in very limited number, the largest number of ABO-incompatible transplantations have been performed. Altogether more than 300 ABO-incompatible kidney transplantations have been performed in more than 40 centres since 1989. ABO-incompatible liver transplantations have been performed mainly in emergency cases and the results have generally been inferior to ABO-compatible grafts. In children below the age of three years, liver transplantations across the ABO-barrier have been quite successful especially with living related donors. Very few ABO-incompatible heart/heart-lung/lung-transplantations have been reported with a few successful cases, but the majority have been failures. Recently a series of ABO-incompatible heart transplants performed in small children have been reported with a high success rate.

ABO-incompatibility in solid organ transplantation

https://www.journal-of-hepatology.eu/article/S0168-8278(15)00158-0/pdf

From immunosuppression to tolerance

spillover, sinusoidal endotheliitis, perivenular inflammation 5 necrosis, and arteritis) are used to upgrade the overall severity of acute reje~tion.’~

https://aasldpubs.onlinelibrary.wiley.com/doi/pdf/10.1002/hep.1840220239

Terminology for hepatic allograft rejection

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 pathological 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 less than 002) 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 immunoflourescent 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

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

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