HLA matching and rabbit antithymocyte globulin as induction therapy to avoid multiple forms of rejection after a third liver transplantation

Aafke A. Duizendstra, Michail Doukas, Michiel G.H. Betjes, Thierry P.P. van den Bosch, Sarwa Darwish Murad, Nicolle H.R. Litjens, Dave Sprengers, Jaap Kwekkeboom*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
14 Downloads (Pure)


Background: Despite immunosuppressive drug regimens, T cell-mediated rejection, antibody-mediated rejection with donor-specific antibodies, and chronic rejection occur after liver transplantation (LTx). Rejection may significantly impact allograft survival and often a standard re-LTx is required. However, in some cases rejection recurs. Little is known on how to approach this and which aspects to consider. Case: Here we describe a case in which two successive liver grafts where lost due to T cell-mediated rejection, possible antibody-mediated rejection with de novo donor-specific antibody formation, and chronic rejection that occurred within a month. In an attempt to avoid recurrence with the third graft, we decided to administer a more rigorous immunosuppressive drug induction regimen with rabbit antithymocyte globulin, while applying HLA matching between recipient and donor. This resulted in rejection free survival for 337 days until a mild T cell-mediated rejection occurred, which could then be easily treated with high dose steroids. Graft survival is now at least 683 days without chronic rejection, antibody-mediated rejection or de novo donor-specific antibody formation. Conclusion: In conclusion, when a liver graft is lost due to multiple forms of rejection short after LTx, the combination applied in this case could be considered as a viable option to improve graft and patient survival instead of a standard re-LTx.

Original languageEnglish
Article number101539
JournalClinics and Research in Hepatology and Gastroenterology
Issue number3
Publication statusPublished - May 2021

Bibliographical note

Funding Information:
This work was supported by the Erasmus MC PhD-grant (MRACE; 2015 the Netherlands) .

Publisher Copyright:
© 2020 The Authors


Dive into the research topics of 'HLA matching and rabbit antithymocyte globulin as induction therapy to avoid multiple forms of rejection after a third liver transplantation'. Together they form a unique fingerprint.

Cite this