Application and interpretation of histocompatibility data in liver transplantation

Purpose of review ere has been a resurgence of interest in histocompatibility as it applies to liver transplantation. e association of persistent and de-novo donor specific antibody (DSA) and outcomes after liver transplantation continues to be investigated. Recent findings Consensus continues to evolve regarding e existence of acute and chronic antibody-mediated rejection (AMR) and paogenicity of DSA and associated paologic findings after liver transplantation. e presence of persistent high level, complement fixing DSA or emergence of de novo, Class II DSA has been associated wi rejection and worse long-term graft and patient survival. Significant adverse associations of DSA extend to patients after simultaneous liver kidney (SLK) transplant as well as in pediatric recipients of liver transplantation. A higher degree of HLA incompatibility has been recently associated wi worse outcomes in living donor liver transplant. Summary In summary, recent consensus guidelines describe and recognize e existence of acute and chronic AMR and provide a basis upon which to build furer investigation. Important adverse outcomes including decreased survival, allograft failure and liver fibrosis have been linked to e presence of DSA. Routine donor and recipient HLA typing and DSA assessment will facilitate diagnosis and provide for baseline data, which may help guide future management. Future investigations may help to clarify e role of erapeutic interventions.