{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:52:31Z","timestamp":1785423151648,"version":"3.56.0"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2011,4,1]],"date-time":"2011-04-01T00:00:00Z","timestamp":1301616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2011,3,28]],"date-time":"2011-03-28T00:00:00Z","timestamp":1301270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2011,4]]},"abstract":"<jats:sec>\n            <jats:title>Abstract<\/jats:title>\n            <jats:p>The importance of antibody-mediated rejection (AMR) in ABO-compatible liver transplantation is controversial. Here we report a prospective series of liver recipients with a preoperative positive crossmatch. To establish the diagnosis of AMR in liver recipients, the criteria described for kidney allografts were adopted. In approximately 10% of 197 liver transplants, we observed a positive T and B cell flow crossmatch before transplantation. Fifteen of 19 patients converted to negative crossmatches early after transplantation and displayed normal liver function while they were on routine immunosuppression. Four patients maintained positive crossmatches. Three of the 4 met the criteria for AMR and showed evidence of graft dysfunction, the presence of donor-specific antibodies (DSAs), morphological tissue destruction with positive C4d linear staining on the graft sinusoidal endothelium, and improved function with attempts to eliminate DSAs. A persistently positive crossmatch after liver transplantation may lead to early, severe AMR and liver failure. C4d staining in the liver sinusoidal endothelium should alert one to the possibility of AMR. In our experience, patients with a positive crossmatch should have it repeated at 2 weeks and, if it is positive, again at 3 to 5 weeks. Recipients with an unknown preoperative crossmatch who develop early cholestasis of unclear etiology should be crossmatched or tested for the presence of DSAs to evaluate for AMR. <jats:bold>\n                                    Liver Transpl, 2011. \u00a9 2011 AASLD.\n                                 <\/jats:bold>\n                              <\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.22233","type":"journal-article","created":{"date-parts":[[2010,12,3]],"date-time":"2010-12-03T16:45:35Z","timestamp":1291394735000},"page":"357-368","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":145,"title":["Liver allograft antibody-mediated rejection with demonstration of sinusoidal C4d staining and circulating donor-specific antibodies"],"prefix":"10.1097","volume":"17","author":[{"given":"Tomasz","family":"Kozlowski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara","family":"Rubinas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volker","family":"Nickeleit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Woosley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Schmitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Passannante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Andreoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-2-20250124","doi-asserted-by":"crossref","first-page":"3022","DOI":"10.1111\/j.1600-6143.2006.01554.x","article-title":"Isolated donor specific alloantibody-mediated rejection after ABO compatible liver transplantation.","volume":"6","author":"Watson","year":"2006","journal-title":"Am J Transplant"},{"key":"R2-2-20250124","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1055\/s-2007-1007376","article-title":"Immunopathology of antibodies as effectors of orthotopic liver allograft rejection.","volume":"12","author":"Demetris","year":"1992","journal-title":"Semin Liver Dis"},{"key":"R3-2-20250124","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1111\/j.1432-2277.2008.00775.x","article-title":"Humoral and cellular rejection after combined liver-kidney transplantation in low immunologic risk recipients.","volume":"22","author":"Hadaya","year":"2009","journal-title":"Transpl Int"},{"key":"R4-2-20250124","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/j.1432-2277.2009.00954.x","article-title":"Fatal impact of lymphocyte cross-matching upon humoral rejection after adult living related liver transplantation.","volume":"23","author":"Hori","year":"2010","journal-title":"Transpl Int"},{"key":"R5-2-20250124","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/00007890-199902270-00014","article-title":"Postoperative flow cytometry crossmatch in living donor liver transplantation: clinical significance of humoral immunity in acute rejection.","volume":"67","author":"Kasahara","year":"1999","journal-title":"Transplantation"},{"key":"R7-2-20250124","doi-asserted-by":"crossref","first-page":"1957","DOI":"10.1111\/j.1600-6143.2009.02714.x","article-title":"Acute humoral rejection in an ABO compatible combined liver-kidney transplantthe kidney is not always protected.","volume":"9","author":"Reichman","year":"2009","journal-title":"Am J Transplant"},{"key":"R8-2-20250124","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1097\/00007890-199612270-00019","article-title":"The impact of a positive crossmatch upon outcome after liver 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A case report.","volume":"40","author":"Della-Guardia","year":"2008","journal-title":"Transplant Proc"},{"key":"R12-2-20250124","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1002\/hep.1840160310","article-title":"A clinicopathological study of human liver allograft recipients harboring preformed IgG lymphocytotoxic antibodies.","volume":"16","author":"Demetris","year":"1992","journal-title":"HEPATOLOGY"},{"key":"R13-2-20250124","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1002\/hep.1840210519","article-title":"Immunoglobulin G lymphocytotoxic antibodies in clinical liver transplantation: studies toward further defining their significance.","volume":"21","author":"Manez","year":"1995","journal-title":"HEPATOLOGY"},{"key":"R14-2-20250124","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/S0198-8859(02)00429-9","article-title":"Is presensitization relevant to liver transplantation outcome?","volume":"63","author":"Bishara","year":"2002","journal-title":"Hum Immunol"},{"key":"R15-2-20250124","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.cld.2007.11.001","article-title":"Intrahepatic cholestasis after liver transplantation.","volume":"12","author":"Corbani","year":"2008","journal-title":"Clin Liver Dis"},{"key":"R16-2-20250124","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jhep.2008.07.032","article-title":"Altered bile composition after liver transplantation is associated with the development of nonanastomotic biliary strictures.","volume":"50","author":"Buis","year":"2009","journal-title":"J Hepatol"},{"key":"R17-2-20250124","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1002\/lt.20420","article-title":"Biliary epithelial cell antibodies induce expression of toll-like receptors 2 and 3: a mechanism for post-liver transplantation cholangitis?","volume":"11","author":"Ge","year":"2005","journal-title":"Liver Transpl"},{"key":"R19-2-20250124","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/j.1600-6143.2005.01185.x","article-title":"Antibody-mediated rejection of a pancreas allograft.","volume":"6","author":"Melcher","year":"2006","journal-title":"Am J Transplant"},{"key":"R20-2-20250124","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1034\/j.1600-6143.2003.00152.x","article-title":"Use of C4d as a diagnostic adjunct in lung allograft biopsies.","volume":"3","author":"Magro","year":"2003","journal-title":"Am J Transplant"},{"key":"R21-2-20250124","doi-asserted-by":"crossref","first-page":"2778","DOI":"10.1111\/j.1600-6143.2005.01074.x","article-title":"3rd. Antibody-mediated rejection in human cardiac allografts: evaluation of immunoglobulins and complement activation products C4d and C3d as markers.","volume":"5","author":"Rodriguez","year":"2005","journal-title":"Am J Transplant"},{"key":"R22-2-20250124","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1111\/j.1600-6143.2008.02159.x","article-title":"Banff 07 classification of renal allograft pathology: updates and future directions.","volume":"8","author":"Solez","year":"2008","journal-title":"Am J Transplant"},{"key":"R23-2-20250124","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1600-6143.2009.02987.x","article-title":"Banff 09 meeting report: antibody mediated graft deterioration and implementation of Banff working groups.","volume":"10","author":"Sis","year":"2010","journal-title":"Am J Transplant"},{"key":"R24-2-20250124","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1111\/j.1600-6143.2004.00500.x","article-title":"National conference to assess antibody-mediated rejection in solid organ transplantation.","volume":"4","author":"Takemoto","year":"2004","journal-title":"Am J Transplant"},{"key":"R25-2-20250124","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1681\/ASN.V131242","article-title":"Detection of the complement degradation product C4d in renal allografts: diagnostic and therapeutic implications.","volume":"13","author":"Nickeleit","year":"2002","journal-title":"J Am Soc Nephrol"},{"key":"R26-2-20250124","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1097\/ALN.0b013e3181d049f0","article-title":"Plasma proteome to look for diagnostic biomarkers of early bacterial sepsis after liver transplantation: a preliminary study.","volume":"112","author":"Paugam-Burtz","year":"2010","journal-title":"Anesthesiology"},{"key":"R27-2-20250124","first-page":"54","article-title":"Predicting bacteremia and bacteremic mortality in liver transplant 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Arch"},{"key":"R43-2-20250124","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1038\/modpathol.3800784","article-title":"Significance of C4d staining in ABO-identicalcompatible liver transplantation.","volume":"20","author":"Sakashita","year":"2007","journal-title":"Mod Pathol"},{"key":"R44-2-20250124","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1111\/j.1365-2559.2007.02677.x","article-title":"C4d immunopositivity is uncommon in ABO-compatible liver allografts, but correlates partially with lymphocytotoxic antibody status.","volume":"50","author":"Bellamy","year":"2007","journal-title":"Histopathology"},{"key":"R46-2-20250124","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1093\/ndt\/gfl594","article-title":"C4d staining of renal allograft biopsies: a comparative analysis of different staining techniques.","volume":"22","author":"Seemayer","year":"2007","journal-title":"Nephrol Dial Transplant"}],"container-title":["Liver 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