Induction with anti-T-lymphocyte globulins and human immunoglobulins: A strategy for hyperimmunized liver transplant patients

Table 4 Short- and long-term outcomes of histological rejection after transplantation in the high-risk group

	Rejection type	CM	DSA at LT (MFI)	Time to rejection from LT	BANFF score	C4d	Cholestasis	Other causes of cholestasis	DSA at time of rejection	Treatment	Follow up
1	TCMR	Positive	-	Day 7	6	Negative	Yes	No	-	Increase CNI dose	Died (sepsis; day 9 post-LT)
2	TCMR	Positive	I (9175); II (8575)	Year 2	4	Negative	No	No	-	No	Normal
3	TCMR	Positive	I (22544); II (3314)	Day 7	4	Negative	Yes	No	I (2176); II (1528)	Cs. bolus	Normal
4	TCMR	Positive	I (absent); II (2017)	Day 11	6	Negative	No	No	I (absent); II (2700)	Cs. bolus + increase CNI dose	Normal
5	TCMR	Positive	I (19903); II (4539)	Month 3	5	Positive	No	No	I (absent); II (596)	Cs. bolus	Normal
6	TCMR1	Negative	I (728); II (8230)	Day 5	6	Negative	Yes	No	-	Cs. bolus	Normal
7	TCMR1	Negative	I (absent); II (6222)	Day 8	5	Negative	Yes	No	-	No	Normal
8	TCMR	Positive	-	Day 7	5	Negative	No	No	-	No	Normal
9	TCMR	Positive	I (14134); II (2368)	Month 8	7	Negative	Yes	No	-	Cs. bolus	ECR (at month 18 post LT)
10	aAMR	Positive	I (57135)2; II (absent)	Day 54	3	Positive	Yes	No	I (31075); II (absent)	Cs. bolus + IVIG	ECR (at month 19 post LT)
11	aAMR1	Positive	I (3965)3; II (44601)	Day 91	3	Positive	Yes	No	I (absent); II (4990)	Switch from cyclosporin to tacrolimus	ECR (at month 20 post LT)
12	aAMR TCMR	Positive	I (21465)4; II (2452)	Day 8	4	Positive	Yes	No	I (83711); II (1484)	Cs. bolus + rituximab + 5 sessions of PE	Re-LT for biliary anastomotic stricture
13	aAMR TCMR	Positive	I (35341)5; II (50000)	Day 18	5	Positive	Yes	No	I (4500); II (6000)	Cs. bolus + IVIG	Normal

¹Previous liver transplantation, titers of donor specific antibodies > 5000.

²A2: 20648, A24: 1482, B56: 17979, B62: 14613.

³B2:3965, DQ5: 22007, DQ6; 22594.

⁴A33: 557, B65: 7008, B71: 3248, C10: 5637, C8: 5015, DR13: 840, DP3: 696, DQ5: 916.

⁵A24: 9500, B13: 12700, B7: 13141, DR15: 22100, DR51: 23300, DQ5: 2200, DR13: 2400.

aAMR: Acute antibody-mediated rejection; TCMR: T-cell-mediated rejection; CM: Crossmatch; CNI: Calcineurin inhibitors; Cs.: Corticosteroids; C4d: Complement component 4d; DSA: Donor specific antibodies; ECR: Early chronic rejection; IVIG: Intravenous immunoglobulin; LT: Liver transplantation; MFI: Mean fluorescence intensity; PE: Plasma exchange.