Lactic Acidosis, Hypoglycemia, and Eosinophilia: Novel Markers of Antibody-Mediated Rejection Causing Graft Ischemia

Historically, minimal significance has been given to the humoral immune response after liver transplantation and, despite antibodies against HLA antigens being present in 10-20% of patients awaiting transplant, the incidence of antibody mediated rejection (AMR) after ABO compatible (ABO-C) liver transplantation is low (1).Donor Specific Antibodies (DSA) can lead to early graft loss (2), but most patients awaiting liver transplant are not screened for HLA sensitisation and serum DSA measurement are only undertaken if AMR is suspected. We describe two cases of AMR occurring within one week of ABO-C liver transplantation with previously unreported biochemical and histological characteristics.