Abstract
Objective To summary the diagnosis and therapy of antibody-mediated rejection (AMR) caused by donor specific antibody (DSA) in pediatrics after living donor liver transplantation. Methods The clinical data of total 4 pediatric recipients with biliary atresia after liver transplantation were retrospectively analyzed. Liver biopsy was performed and HLA antibodies were detected by Luminex. The abnormal graft function was found. Results The concentrations of immunosuppressant were very low pre-AMR-diagnosed. DSA was detected in total 4 patients with the most DSA at HLA-II antibodies. Staining of C4d was positive in liver biopsies in 3 of 4 recipients. The patients were gvien plasmapheresis, intravenous immunoglobulin, mycophenolate mofetil and rituximab post-diagnosis. However, only 1 patient was cured with normal graft function and negative DSA. The rest of patients received re-transplantation because of ineffective treatment and showed a well graft function during the follow-up period. Conclusion AMR induced by DSA was rare complaint after pediatric liver transplantation, with serious consequence and poor prognosis. AMR in some patients can be cured by conservative therapies as being diagnosed definitely. However, re-transplantation was one of the valid therapies to AMR. Key words: Living donor; Pediatrics; Liver transplantation; Donor specific antibody; Graft rejection; Antibody mediated
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