The detrimental effects of Donor Specific HLA alloantibodies (DSA) on outcomes following liver organ transplantation have been known for many years.
Liver transplantation is an exception but some evidence has been recently highlighted, showing that DSA could be associated with acute antibody-mediated rejection, chronic rejection, plasma cell hepatitis, anastomotic biliary stricture, NRH, fibrosis progression... The prevalence of preformed donor specific DSA is about 20% and the incidence of de novo DSA is about 10% in Liver transplantation (LT). DSA are associated with several graft diseases, mainly AMR but diagnosis was made on histological features+/-C4d staining. De novo DSA and preformed class II DSA, especially with high MFI, seem to pejoratively influence outcomes after LT. When associated with HCV, DSA worsen fibrosis progression. Thanks to antiviral IFN-free regimen, therapeutic strategies of DSA positivity and/or AMR will not differ from HCV- recipients, but need to be evaluated in prospective studies.