case_images: PMC3959345_01
case_images: Recipient's lymphocyte reactivity against HLA class I and II antigens. Recipient lymphocytes had obvious immunoreactivity against donor HLA class I antigens, though reactivity against donor HLA class II antigens was below the threshold level. The threshold level was 1.53 (horizontal lines)
case_images: AnnGastroenterol-25-66-g001.jpg
case_images: PMC3959345_01_AnnGastroenterol-25-66-g001.jpg
case_images: F1
case_images: Moreover, the patient showed strong reactions against donor HLA Class I antigens (Fig. 1).
case_images: Recipient pre-transplant immunoreactivity against donor antigens, as assessed by FCM. The recipient's lymphocytes clearly show reactivity against donor HLA class I antigens (arrows). The vertical lines represent reactivity against the same antigen in a third party (other recipients).
case_images: AnnGastroenterol-25-66-g002.jpg
case_images: PMC3959345_01_AnnGastroenterol-25-66-g002.jpg
case_images: F2
case_images: Also, flow cytometry (FCM) showed that the lymphocytes of the recipient were reactive against HLA Class I antigens (Fig. 2).
case_images: Serological HLA typing of both the recipient and donor and the recipient's lymphocyte immunoreactivity against specific HLA class I antigens. The recipient was not homozygous for HLA loci. The donor has the HLA-B 55 locus (underlined). The recipient's lymphocytes show specific activity against HLA-B locus 55 (black arrow).
case_images: AnnGastroenterol-25-66-g003.jpg
case_images: PMC3959345_01_AnnGastroenterol-25-66-g003.jpg
case_images: F3
case_images: The HLA typing of both the recipient and the donor is shown (Fig. 3). Tests showed that the donor had this HLA B locus (Fig. 3), which meant that the patient could potentially mount a donor-specific anti-HLA antibody response after transplantation.
case_images: Changes in the patient's blood biochemistry after LDLT. Temporal changes in each of the variables are represented as follows: closed square, AST; closed circle, LDH; open circle, T-Bil; open square, PT-INR; closed triangle, lactate.
case_images: AnnGastroenterol-25-66-g004.jpg
case_images: PMC3959345_01_AnnGastroenterol-25-66-g004.jpg
case_images: F4
case_images: Plasma exchange (PE) (80 mL/kg/d) was performed daily after POD 4 (Fig. 4) and she received steroid pulse therapy (methylprednisolone at 10 mg/kg, i.v.) from POD 5.
case_images: Histopathological findings from liver needle biopsy. The hematoxylin-eosin stained specimens show massive necrosis of hepatocytes and disappearance of bile ducts (A and B). C4d immunostaining shows endothelial-positive (C) and stromal-positive (D) staining in portal areas. These findings indicate humoral rejection.
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case_images: PMC3959345_01_AnnGastroenterol-25-66-g005.jpg
case_images: F5
case_images: Histopathological examination clearly showed severe graft damage (Fig. 5).