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J.G.O’Leary, A.J.Demetris, L.S.Friedman, H.M.Gebel, P.F.Halloran, A.D.Kirk, S.J.Knechtle, S.V.McDiarmid, A.Shaked, P.I.Terasaki, K.J.Tinckam, S.J.Tomlanovich, K.J.Wood, E.S.Woodle, A.A.Zachary and G.B.Klintmalm

Several insights emerged. Acute antibody-mediated rejection (AMR), although rarely diagnosed, is increasingly understood to overlap with T cell–mediated rejection. Isolated liver allograft recipients are at increased risk of early allograft immunologic injury when preformed DSA are high titer and persist posttransplantation. Persons who undergo simultaneous liver–kidney transplantation are at risk of renal AMR when Class II DSA persist posttransplantation. Other under-appreciated DSA associations include ductopenia and fibrosis, plasma cell hepatitis, biliary strictures and accelerated fibrosis associated with recurrent liver disease. Standardized DSA testing and diagnostic criteria for both acute and chronic AMR are needed to distil existing associations into etiological processes in order to develop responsive therapeutic strategies.

Keywords: Antibody-mediated rejection, donor-specific HLA antibodies, graft outcomes, liver transplant, renal transplant, simultaneous liver–kidney transplant.

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