Acute liver allograft antibody-mediated rejection: An inter-institutional study of significant histopathological features

Acute antibody-mediated rejection (AMR) occurs in a small minority of sensitized liver transplant recipients. Although histopathological characteristics have been described, specific features that could be used (1) to make a generalizable scoring system and (2) to trigger a more in-depth analysis are needed to screen for this rare but important finding. Toward this goal, we created training and validation cohorts of putative acute AMR and control cases from 3 high-volume liver transplant programs; these cases were evaluated blindly by 4 independent transplant pathologists. Evaluations of hematoxylin and eosin (HE however, a definitive diagnosis requires substantiation by DSA testing, diffuse C4d staining, and the exclusion of other insults. Liver Transpl 20:1244-1255, 2014. © 2014 AASLD.