Rethinking de novo immune hepatitis,an old concept for liver allograft rejection:relevance of glutathione S-transferase T1 mismatch

作     者：Isabel Aguilera Elena Aguado-Dominguez Jose Manuel Sousa Antonio Nunez-Roldan 

作者机构：Department of ImmunologyInstituto de Biomedicina de Sevilla(IBIS)Hospital Universitario Virgen del RocíoSevilla 41013Spain Digestive and Liver Diseases ServiceHospital Universitario Virgen del RocíoSevilla 41013Spain 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2018年第24卷第29期

页      面：3239-3249页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by Andalusian government,Proyecto de Excelencia,No.CTS-7846 Spanish Ministry of Economy,Instituto de Salud Carlos Ⅲ,No.11/857 and No.17/1403 

主　　题：glutathione S-transferase T1 mismatch liver allograft rejection plasma cell-rich rejection de novo autoimmune hepatitis donor-specific antibodies newCAST cell quantification IgG4+plasma cell T lymphocytes 

摘      要：Antibody-mediated rejection(AMR) in liver transplantation has long been underestimated. The concept of the liver as an organ susceptible to AMR has emerged in recent years, not only in the context of the major histocompatibility complex with the presence of HLA donor-specific antibodies, but also with antigens regarded as minor, whose role in AMR has been demonstrated. Among them, antibodies against glutathione S-transferase T1 have been found in 100% of patients with de novo autoimmune hepatitis(dn AIH) when studied. In its latest update, the Banff Working Group for liver allograft pathology proposed replacing the term dn AIH with plasma cell(PC)-rich rejection. Antibodies to glutathione S-transferase T1(GSTT1) in null recipients of GSTT1 positive donors have been included as a contributory but nonessential feature of the diagnosis of PC-rich rejection. Also in this update, non-organ-specific anti-nuclear or smooth muscle autoantibodies are no longer included as diagnostic criteria. Although initially found in a proportion of patients with PC-rich rejection, the presence of autoantibodies is misleading since they are not diseasespecific and appear in many different contexts as bystanders. The cellular types and proportions of the inflammatory infiltrates in diagnostic biopsies have been studied in detail very recently. PC-rich rejection biopsies present a characteristic cellular profile with a predominance of T lymphocytes and a high proportion of PCs, close to 30%, of which 16.48% are Ig G4+. New data on the relevance of GSTT1-specific T lymphocytes to PC-rich rejection will be discussed in this review.