期刊
WORLD JOURNAL OF GASTROENTEROLOGY
卷 24, 期 29, 页码 3239-3249出版社
BAISHIDENG PUBLISHING GROUP INC
DOI: 10.3748/wjg.v24.i29.3239
关键词
glutathione S-transferase T1 mismatch; liver allograft rejection; plasma cell-rich rejection; De novo autoimmune hepatitis; donor-specific antibodies; newCAST; cell quantification; IgG4(+) plasma cell; T lymphocytes
资金
- Andalusian Government, Proyecto de Excelencia [CTS-7846]
- Spanish Ministry of Economy, Instituto de Salud Carlos III [11/857, 17/1403]
Antibody-mediated rejection (AMR) in liver transplantation has long been underestimated. The concept of the liver as an organ susceptible to AMR has emerged in recent years, not only in the context of the major histocompatibility complex with the presence of HLA donor-specific antibodies, but also with antigens regarded as minor, whose role in AMR has been demonstrated. Among them, antibodies against glutathione S-transferase T1 have been found in 100% of patients with de novo autoimmune hepatitis (dnAIH) when studied. In its latest update, the Banff Working Group for liver allograft pathology proposed replacing the term dnAIH with plasma cell (PC)-rich rejection. Antibodies to glutathione S-transferase T1 (GSTT1) in null recipients of GSTT1 positive donors have been included as a contributory but nonessential feature of the diagnosis of PC-rich rejection. Also in this update, non-organ-specific anti-nuclear or smooth muscle autoantibodies are no longer included as diagnostic criteria. Although initially found in a proportion of patients with PC-rich rejection, the presence of autoantibodies is misleading since they are not disease-specific and appear in many different contexts as bystanders. The cellular types and proportions of the inflammatory infiltrates in diagnostic biopsies have been studied in detail very recently. PC-rich rejection biopsies present a characteristic cellular profile with a predominance of T lymphocytes and a high proportion of PCs, close to 30%, of which 16.48% are IgG4(+). New data on the relevance of GSTT1-specific T lymphocytes to PC-rich rejection will be discussed in this review.
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