Evolution of serum and intra-graft donor-specific anti-HLA antibodies in a patient with two consecutive liver transplantations

•Originality of this work relies in comparison of evolution with time of anti-HLA antibodies in serum and graft to try to understand graft dysfunction.

The current literature suggests that anti-HLA donor-specific antibodies (DSA) may have deleterious effects on liver grafts but there is no proof that they are directly involved in the graft lesions. We report the case of a donor HLA-sensitized patient who needed a second graft 6 months after the first transplantation owing to a progressive cholestatic disease that we could finally attribute to antibody-mediated rejection (AMR). We describe the longitudinal evolution of graft function, tissue histology, serum DSA and, for the first time, intra-graft DSA after elution from biopsies.