Liver transplantation: Current status and challenges

Table 2 Current data for donor-specific HLA-antibody-associated injuries in kidney and liver transplantation

	Kidney transplantation	Liver transplantation
DSA specificity and levels	↑ risk hyperacute rejection[44]; ↑ DSA in new onset late kidney allograft dysfunction[45]; acute AMR is associated with high posttransplant DSA levels[45]	↑ DSA in recipients with CR, presence of IgG3 subclass associated with ↑ risk of graft loss[40]
C4d deposition in microvasculature	Graft failure significantly worse in the presence of C4d+ staining[44]; C4d+ is a marker of antibody-mediated injury[44,46]	C4d+ staining nonspecific; In the presence of DSA, linear portal capillary and sinusoidal staining observed in ACR; DSA negative C4d+ staining found in biliary strictures and recurrent liver disease[47]
DSA subtypes, C1q binding	↓ graft survival and ↑ risk for AMR with C1q-binding DSA[48,49]	Limited data[50]
Microvascular inflammation	Peritubular capillaritis is a possible predictor of chronic AMR[51]; subclinical AMR may contribute to development of CAN[52]	No current data
EC activation by light microscopy	EC and BM ultrastructural abnormalities in glomerular and peritubular capillaries are early markers of TXG[53]	No current data
Gene expression profile of chronic AMR	Defined genetic profile in AMR[54,55]	No current data
Therapeutic-trials to prevent DSA-associated injury	Bortezomib (plasma cell-targeted therapy) as a possible antihumoral therapy[56]; plasma exchange for AMR[57,58]	No current data

Modified from Ref. 43. AMR: Antibody-mediated rejection; CAN: Chronic allograft nephropathy; EC: Endothelial cell; BM: Basement membrane; DSA: Donor-specific HLA-antibody; TXG: Transplant glomerulonephropathy.