Acute Antibody-Mediated Rejection as Cause of Late Liver Allograft Failure: A Case Report

•Antibody-mediated rejection (AMR) after liver transplantation is a highly mortal complication.•Late acute AMR in patients with de novo DSA is infrequent and remains to be well characterized.•In the context of hepatitis C recurrence, underimmunosuppression could be a triggering factor for AMR.•Differential diagnosis of acute liver failure after transplantation should include AMR.

BackgroundDespite now being an infrequent complication in liver transplantation (LT) recipients, acute liver failure is still associated with high mortality.Case ReportHere we report a case of acute liver failure 11 months after AB0-compatible LT in a hepatitis C–positive 50-year-old male recipient caused by late antibody-mediated rejection (AMR). De novo donor-specific antibodies appeared later in a previously negative donor-recipient crossmatch, leading to a rapid deterioration of liver function.ConclusionsWe highlight the importance of an accurate diagnosis and an early therapeutic intervention. The analysis of this case brings novel and generalizable insights to the differential diagnosis of acute liver failure after LT.