Sinusoidal obstruction syndrome as a manifestation of acute antibody-mediated rejection after liver transplantation.
liver allograft function/dysfunction
liver transplantation/hepatology
nical research/practice
rejection: antibody-mediated (ABMR)
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
revised:
10
05
2021
received:
21
12
2020
accepted:
10
05
2021
pubmed:
20
5
2021
medline:
12
11
2021
entrez:
19
5
2021
Statut:
ppublish
Résumé
Antibody-mediated rejection (AMR) after liver transplantation is uncommon but, when present, manifests as graft dysfunction. We report the case of a 54-year-old woman who developed portal hypertension with pleural effusion and ascites secondary to sinusoidal obstruction syndrome (SOS) due to acute AMR following an ABO-matched liver transplantation for autoimmune cirrhosis and hepatocellular carcinoma. Initial immunosuppression comprised basiliximab, decreasing prednisone, tacrolimus, and mycophenolate mofetil. After 1 month, she presented with the massive pleural effusion, slight ascites, and normal liver tests. After excluding common causes of pleural effusion, we performed a liver biopsy that showed atypical rejection with the involvement of large centrilobular veins partially occluded by marked endotheliitis and lax fibrosis suggestive of SOS. Direct immunofluorescence study of C4d showed diffuse endothelial sinusoidal staining, and de novo donor-specific anti-human leukocyte antigen antibodies were detected in his blood. Thus, we diagnosed AMR focused on centrilobular veins and initiated treatment with defibrotide, steroid pulses, and diuretics. However, this was ineffective, and the pleural effusion only resolved when plasmapheresis and intravenous immunoglobulin were started. This case shows that AMR can cause SOS with portal hypertension and present with a pleural effusion, and as such, it should be suspected after excluding other more common causes of effusion.
Identifiants
pubmed: 34008326
doi: 10.1111/ajt.16689
pii: S1600-6135(22)08810-4
doi:
Substances chimiques
Antibodies
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
3775-3779Informations de copyright
© 2021 The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Wesson RN, Etchill EW, Garonzik-Wang J. Application and interpretation of histocompatibility data in liver transplantation. Curr Opin Organ Transplant. 2017;22(5):499-504.
Vandevoorde K, Ducreux S, Bosch A, et al. Prevalence, risk Factors, and impact of donor-specific alloantibodies after adult liver transplantation. Liver Transpl. 2018;24(8):1091-1100.
Demetris AJ, Jaffe R, Tzakis A, et al. Antibody-mediated rejection of human orthotopic liver allografts: transplantation across ABO blood group barriers. Am J Pathol. 1989;21(1 Pt 2):2217-2220.
Demetris AJ, Bellamy C, Hübscher SG, et al. 2016 comprehensive update of the Banff working group on liver allograft pathology: introduction of antibody-mediated rejection. Am J Transplant. 2016;16(10):2816-2835.
Valla DC, Cazals-Hatema D. Sinusoidal obstruction syndrome. Clin Res Hepatol Gastroenterol. 2016;40(4):378-385.
Alonso JC. Pleural effusions and liver disease. Semin Respir Crit Care Med. 2010;31(6):698-705.
Sese E, Xiol X, Castellote J, et al. Low complement levels and opsonic activity in hepatic hydrothorax: its relationship with spontaneous bacterial empyema. J Clin Gastroenterol. 2003;36(1):75-77.
Lee M. Antibody-mediated rejection after liver transplant. Gastroenterol Clin North Am. 2017;46(2):297-309.
Vionnet J, Sempoux C, Pascual M, et al. Donor-specific antibodies in liver transplantation. Gastroenterol Hepatol. 2019;43(1):34-45.
O'Leary JG, Kaneku H, Banuelos N, et al. Impact of IgG3 subclass and C1q-fixing donor-specific HLA alloantibodies on rejection and survival in liver transplantation. Am J Transplant. 2015;15(4):1003-1013.
Taner T, Gandhi MJ, Sanderson SO, et al. Prevalence, course and impact of HLA donor-specific antibodies in liver transplantation in the first year. Am J Transplant. 2012;12(6):1504-1510.
Del Bello A, Congy-Jolivet N, Muscari F, et al. Prevalence, incidence and risk factors for donor-specific anti-HLA antibodies in maintenance liver transplant patients. Am J Transplant. 2014;14(4):867-875.
Del Bello A, Congy-Jolivet N, Danjoux M, et al. De novo donor-specific anti-HLA antibodies mediated rejection in liver-transplant patients. Transpl Int. 2015;28(12):1371-1382.
Hogen R, DiNorcia J, Dhanireddy K. Antibody-mediated rejection: what is the clinical relevance? Curr Opin Organ Transplant. 2017;22(2):97-104.
Demetris AJ, Zeevi A, O’Leary JG. ABO-compatible liver allograft antibody-mediated rejection: an update. Curr Opin Organ Transplant. 2015;20(3):314-324.
Del Bello A, Danjoux M, Congy-Jolivet N, et al. Histological long-term outcomes from acute antibody-mediated rejection following ABO-compatible liver transplantation. J Gastroenterol Hepatol. 2017;32(4):887-893.
Cuadrado A, San Segundo D, López-Hoyos M, et al. Clinical significance of donor-specific human leukocyte antigen antibodies in liver transplantation. World J Gastroenterol. 2015;21(39):11016-11026.