The distinction between autoimmune and alloimmune reactions in liver transplant recipients can be challenging. Plasma cell-rich rejection (PCRR), previously known as de novo autoimmune hepatitis or plasma cell hepatitis, is an atypical and underrecognized form of allograft rejection observed post-liver transplantation, often in conjunction with features of T cell–mediated and antibody-mediated rejection. If PCRR is not recognized and treated with prompt immunosuppressive augmentation, patients can develop advanced hepatic fibrosis, necroinflammation, and allograft failure. Given the significant morbidity and mortality associated with PCRR, there exists a need to develop noninvasive biomarkers which can be used in screening, diagnosis, and treatment monitoring of PCRR. This study is a literature review of candidate serum-based and tissue-based biomarkers in adult and pediatric liver transplant PCRR. We also discuss biomarkers from plasma cell-rich processes observed in other disease states and other organ transplant recipients that might be tested in liver transplant PCRR. We conclude with proposed future directions in which biomarker implementation into clinical practice could lead to advances in personalized management of PCRR.

中文翻译：

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肝移植受者富含浆细胞排斥反应的血清和组织生物标志物


肝移植受者自身免疫反应和同种免疫反应之间的区别可能具有挑战性。浆细胞富集排斥反应 （PCRR），以前称为新发自身免疫性肝炎或浆细胞肝炎，是肝移植后观察到的一种非典型且未被充分认识的同种异体移植物排斥反应形式，通常与 T 细胞介导和抗体介导的排斥反应特征相结合。如果 PCRR 未被识别并及时进行免疫抑制增强治疗，患者可发展为晚期肝纤维化、坏死性炎症和同种异体移植失败。鉴于与 PCRR 相关的显着发病率和死亡率，需要开发可用于 PCRR 筛查、诊断和治疗监测的无创生物标志物。本研究是对成人和儿童肝移植 PCRR 中候选血清和组织生物标志物的文献综述。我们还讨论了在其他疾病状态和其他器官移植受者中观察到的富含浆细胞过程的生物标志物，这些生物标志物可能在肝移植 PCRR 中进行测试。我们总结了拟议的未来方向，在这些方向中，生物标志物在临床实践中的实施可能会导致 PCRR 个性化管理的进步。