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Donor Specific Antibody Negative Antibody-Mediated Rejection after ABO Incompatible Liver Transplantation
J Korean Soc Transplant 2018;32:108-112
Published online December 31, 2018
© 2018 The Korean Society for Transplantation.

Boram Lee, M.D.1, Soomin Ahn, M.D.2, Haeryoung Kim, Ph.D.3, Ho-Seong Han, Ph.D.1,
Yoo-Seok Yoon, Ph.D.1, Jai Young Cho, Ph.D.1 and Young Rok Choi, M.D.1

Departments of Surgery1 and Pathology2, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine3, Seoul, Korea
Correspondence to: Young Rok Choi
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea
Tel: 82-31-787-7111, Fax: 82-31-787-4055
Received July 6, 2018; Revised September 6, 2018; Accepted September 13, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Antibody-mediated rejection (AMR) is a major complication after ABO-incompatible liver transplantation. According to the 2016 Banff Working Group on Liver Allograft Criteria for the diagnosis of acute AMR, a positive serum donor specific antibody (DSA) is needed. On the other hand, the clinical significance of the histological findings of AMR in the absence of DSA is unclear. This paper describes a 57-year-old man (blood type, O+) who suffered from hepatitis B virus cirrhosis with hepatocellular carcinoma. Pre-operative DSA and cross-matching were negative. After transplantation, despite the improvement of the liver function, acute AMR was observed in the protocol biopsy on postoperative day 7; the cluster of differentiation 19+ (CD19+) count was 0% and anti-ABO antibody titers were 1:2. This paper presents the allograft injury like AMR in the absence of DSA after ABOi living donor liver transplantation with low titers of anti-ABO antibody and depleted serum CD19+ B cells.
Keywords : Liver transplantation, Antibody-dependent cell cytotoxicity, Rejection, Living donors, HLA antigens

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