Donor-specific antibodies (DSA) and antibody mediated rejection (AMR) are associated with decreased graft survival in pediatric liver transplantation; however, the incidence of AMR is not well-defined. A retrospective review of 33 consecutive pediatric liver transplants from 2013 March to 2016 July, 32 patients age range 0-17 years-old. Episodes of rejection were identified by post-operative elevation of transaminases, and confirmed with biopsy. DSA testing was sent at the time of suspected rejection. 56.2% had at least one episode of rejection, diagnosed on biopsy. 15.6% had an episode of AMR, at least one DSA with MFI >5000, and C4d positive staining on biopsy. In patients that had AMR, 80% also had an episodes of TCMR. All patients that had AMR, had at least one HLA DQ antibody MFI >5000 present. Previous studies suggest that DQ plays a significant role in AMR. Of patients that had AMR 80% had pre-operative DSA testing, all of which were negative. Pre-operative DSA does not predict AMR. In the majority of cases of AMR results from de novo process DSA production occurring after liver transplantation. Additionally, there appears to be a strong association with HLA-DQ antibodies and AMR.

CITATION INFORMATION: Eriksen C, Zimmerman M, Kim J, Lerret S, Telega G, Vitola B, Schiller J, Hong J. Acute Antibody-Mediated Rejection in Pediatric Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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