Antibody mediated rejection of human liver allografts: transplantation across ABO blood group barriers.

L IVER ALLOGRAfTS are resistant to hyperacute or antibody mediated rejection from preformed antibodies. No consistent syndrome develops following transplantation when a recipient harbors preformed Iymphocytotoxic antibodies.1.2 The only apparent deleterious effect of preformed Iymphocytotoxic antibodies is a higher incidence of the "vanishing hile duct syndrome.") Despite these clinical observations. a phenomenon akin to "hyperacute" rejection can be seen following liver transplantation in experimental animals who were previously sensitized to donor antigens.·" Additionally, isolated case reports thought to represent hyperacute rejection of the liver in humans, have appeared over the years.6•1 However. no pathophysiologic mechanisms or means of predicting its occurrence in humans have been proposed. The following study was designed to address this problem. The syndrome of hyperacute rejection was first recognized in renal transplantation when crossing ABO blood group barriers.' A similar process developed when a recipient harbored preformed Iymphocytotoxic antiOOdies.9 We therefore took advantage of this historical perspective and embarked on a detailed study of liver allografts across ABO blood group barriers. Analysis of the patient's course and pathology specimens revealed a significantly (p < 0.05) higher rate of early graft failure (d weeks) in ABO incompatible (ABO-I) grafts when compared to ABO compatible (ABO-C), age. sex and priority matched controls. Study of these cases allowed for the recognition of antibody mediated rejection of human liver allografts and for the development of criteria for esta blishing the diagnosis.