Antibody-mediated rejection in liver transplantation- An unresolved puzzle

Antibody-mediated rejection (AMR) in liver transplantation is a frequently underestimated contributor to allograft injury. Despite advancements in defining acute and chronic AMR, challenges persist in timely identification and effective management. The complexities arise from the intricate nature of diagnosis, the absence of standardized treatment protocols, and uncertainties regarding long-term outcomes.

Understanding the specific antibodies involved, their target antigens on liver cells, and the mechanisms of complement activation is crucial for developing targeted therapies. This knowledge gap, coupled with the absence of clear diagnostic criteria and standardized treatments, adds to the intricacy of addressing AMR in liver transplantation.

Heightened clinical awareness and prompt identification of AMR post-liver transplantation are crucial. These efforts not only refine our understanding but also drive future research initiatives and the formulation of effective diagnostic and treatment protocols. Ongoing research aims to unravel AMR complexities through diagnostic tool advancements and refined histopathologic assessments, especially during acute and chronic rejection episodes.

This review delves into recent progress in clinically diagnosing and treating AMR in liver transplantation. It underscores the importance of recognizing specific histopathologic features in liver biopsy tissue during both acute and chronic phases of AMR. By shedding light on these complexities, the review aims to contribute to evolving research, fostering a deeper understanding, and paving the way for more effective management strategies in liver transplantation.