Clinical Features and Treatment of Antibody-Mediated Rejection After Liver Transplantation: A Largest Single Center Experience in China

Antibody-mediated rejection (AMR) is frequently observed in renal transplantation but remains rare and less understood in liver transplantation (LT). This study summarizes the clinical features of AMR in liver transplant patients at our center from August 2020 to October 2023. Thirteen patients were identified as having AMR, including 11 pediatric cases with a median age of 16.2 months. The median interval from transplantation to AMR diagnosis was 54.13 months. Most patients exhibited mild elevation in liver function. A notable decrease in CD4+ T cells was found in acute AMR patients, alongside reduced complement C3 in chronic cases. PRA was positive in 92.31% of patients, all of whom had elevated class II DSA. Additionally, many patients experienced infections with non-hepatotropic viruses. Following intensified immunosuppression and other therapies, 92.31% of patients achieved normal liver function, including five chronic AMR cases with characteristic histological features and seven acute AMR cases that showed no inflammation or centrilobular fibrosis on biopsy. These findings indicate that AMR patients may not exhibit significant liver function abnormalities, emphasizing the critical role of PRA and DSA in diagnosis. The observed reduction in CD4+ T cells and complement C3 may provide valuable insights into the pathogenesis of AMR.