{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T23:41:56Z","timestamp":1790638916810,"version":"4.1.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2014,2,1]],"date-time":"2014-02-01T00:00:00Z","timestamp":1391212800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2014,1,2]],"date-time":"2014-01-02T00:00:00Z","timestamp":1388620800000},"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":[[2014,2]]},"abstract":"<jats:sec>\n            <jats:title\/>\n            <jats:p>We analyzed 60 patients with idiopathic early allograft loss (defined as death or retransplantation at &lt;90 days) to determine the relative contribution of preformed donor-specific human leukocyte antigen alloantibodies (DSAs) to this endpoint, and we defined strict criteria for the diagnosis of antibody-mediated rejection (AMR) in liver allografts. The inclusion criteria encompassed the availability of a pretransplant serum sample and both postreperfusion and follow-up tissue specimens for a blinded, retrospective re-review of histology and complement component 4d (C4d) staining. AMR was diagnosed on the basis of the presence of all 4 of the following strict criteria: (1) DSAs in serum, (2) histopathological evidence of diffuse microvascular injury\/microvasculitis consistent with antibody-mediated injury, (3) diffuse C4d staining in the portal microvasculature with or without staining in the sinusoids or central veins in at least 1 sample, and (4) the exclusion of other causes of a similar type of injury. Patients thought to be experiencing definite AMR on the basis of routine histopathology alone showed the highest levels of DSA sensitization. Forty percent of patients with pretransplant DSAs with a pattern of bead saturation after serial dilutions developed AMR. Another multiparous female developed what appeared to be a strong recall response, which resulted in combined AMR and acute cellular rejection (ACR) causing graft failure. A contribution of DSAs to allograft failure could not be excluded for 3 additional patients who received marginal grafts. In conclusion, liver allograft recipients with preformed DSAs with a high mean fluorescence intensity despite dilution seem to be at risk for clinically significant allograft injury and possibly for loss from AMR, often in combination with ACR. <jats:italic toggle=\"yes\">Liver Transpl 20:218-227, 2014<\/jats:italic>. \u00a9 2013 AASLD.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/lt.23788","type":"journal-article","created":{"date-parts":[[2013,11,6]],"date-time":"2013-11-06T18:32:00Z","timestamp":1383762720000},"page":"218-227","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":112,"title":["Antibody-Mediated Rejection as a Contributor to Previously Unexplained Early Liver Allograft Loss"],"prefix":"10.1097","volume":"20","author":[{"given":"Jacqueline G.","family":"O'Leary","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Kaneku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Demetris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John D.","family":"Marr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle S.","family":"Shiller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"Susskind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn W.","family":"Tillery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul I.","family":"Terasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6ran B.","family":"Klintmalm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-12-20250124","doi-asserted-by":"crossref","first-page":"3745","DOI":"10.1111\/j.1399-0012.1989.tb00531.x","article-title":"Evidence for hyperacute rejection of human liver grafts: the case of the canary kidneys.","volume":"3","author":"Starzl","year":"1989","journal-title":"Clin Transplant"},{"issue":"pt 1","key":"R2-12-20250124","first-page":"396399","article-title":"Positive crossmatch in primary human liver allografts under cyclosporine or FK 506 therapy.","volume":"23","author":"Takaya","year":"1991","journal-title":"Transplant Proc"},{"key":"R3-12-20250124","first-page":"1465","article-title":"Significance of a positive crossmatch on outcome in human liver 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Proc"},{"key":"R7-12-20250124","first-page":"554562","article-title":"Preformed antibodies detected by cytotoxic assay or multibead array decrease liver allograft survival: role of human leukocyte antigen compatibility.","volume":"14","author":"CastilloRama","year":"2008","journal-title":"Liver Transpl"},{"key":"R8-12-20250124","doi-asserted-by":"crossref","first-page":"357368","DOI":"10.1002\/lt.22233","article-title":"Liver allograft antibodymediated rejection with demonstration of sinusoidal C4d staining and circulating donorspecific antibodies.","volume":"17","author":"Kozlowski","year":"2011","journal-title":"Liver Transpl"},{"key":"R9-12-20250124","doi-asserted-by":"crossref","first-page":"641658","DOI":"10.1002\/lt.23403","article-title":"Sinusoidal C4d deposits in liver allografts indicate an antibodymediated response: diagnostic considerations in the evaluation of liver allografts.","volume":"18","author":"Kozlowski","year":"2012","journal-title":"Liver Transpl"},{"key":"R10-12-20250124","doi-asserted-by":"crossref","first-page":"171182","DOI":"10.1111\/j.1600-6143.2011.03786.x","article-title":"Reexamination of the lymphocytotoxic crossmatch in liver transplantation: can C4d stains help in monitoring?","volume":"12","author":"Lunz","year":"2012","journal-title":"Am J Transplant"},{"key":"R11-12-20250124","doi-asserted-by":"crossref","first-page":"676684","DOI":"10.1038\/modpathol.3800784","article-title":"Significance of C4d staining in ABOidenticalcompatible liver transplantation.","volume":"20","author":"Sakashita","year":"2007","journal-title":"Mod Pathol"},{"key":"R12-12-20250124","doi-asserted-by":"crossref","first-page":"500510","DOI":"10.1111\/j.1600-6143.2010.03414.x","article-title":"The significance of donorspecific HLA antibodies in rejection and ductopenia development in ABO compatible liver transplantation.","volume":"11","author":"Musat","year":"2011","journal-title":"Am J 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allografts.","volume":"45","author":"Batts","year":"1988","journal-title":"Transplantation"},{"key":"R16-12-20250124","doi-asserted-by":"crossref","first-page":"476483","DOI":"10.1002\/hep.1840070311","article-title":"The acute vanishing bile duct syndrome (acute irreversible rejection) after orthotopic liver transplantation.","volume":"7","author":"Ludwig","year":"1987","journal-title":"Hepatology"},{"key":"R17-12-20250124","first-page":"945951","article-title":"Evidence for an immune response to HLA class I antigens in the vanishingbileduct syndrome after liver transplantation.","volume":"1","author":"Donaldson","year":"1987","journal-title":"Lancet"},{"key":"R18-12-20250124","first-page":"18681876","article-title":"High mean fluorescence intensity donorspecific antiHLA antibodies associated with chronic rejection postliver transplant.","volume":"11","author":"OLeary","year":"2011","journal-title":"Am J 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An immunocytochemical and clinicopathologic analysis of twenty failed grafts.","volume":"40","author":"Demetris","year":"1985","journal-title":"Transplantation"},{"key":"R39-12-20250124","doi-asserted-by":"crossref","first-page":"152156","DOI":"10.1034\/j.1600-6143.2001.10209.x","article-title":"Susceptibility of liver allografts to high or low concentrations of preformed antibodies as measured by flow cytometry.","volume":"1","author":"Scornik","year":"2001","journal-title":"Am J Transplant"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.23788","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.23788","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-201402000-00012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T17:32:24Z","timestamp":1737739944000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-201402000-00012"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2014]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.23788","relation":{},"ISSN":["1527-6465"],"issn-type":[{"value":"1527-6465","type":"print"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}