A conference was held with an invited faculty (predominantly from the USA) and sponsored by industry to discuss the impact of DSA in liver transplantation and this article reports their opinions.
It was agreed that the presence of DSA are recognised now to have a deleterious effect on outcome, particularly if HLA Class II antibodies, just as was the case for ABO incompatible liver transplants.. These deleterious effects include not only antibody mediated rejection but also bile duct strictures, vanishing bile duct syndrome, plasma cell hepatitis and accelerated fibrosis. The authors feel that there needs to be standardised testing for DSA as well as diagnostic criteria for both acute and chronic AMR. Just as in renal transplantation IgG DSA are likely to be more important than IgM but this still remains unknown.
Overall this is a relatively good summary of current opinion, even if rather parochial. Indeed many key references are not cited. But it is opinion and therefore of limited value as evidence and I would like to see a good systematic review on this topic.