https://www.ncbi.nlm.nih.gov/pubmed/30664572 PFIC
J Pediatr Gastroenterol Nutr. 2019 Feb;68(2):169-174. doi: 10.1097/MPG.0000000000002200.

Alloimmunity and Cholestasis After Liver Transplantation in Children With Progressive Familial Intrahepatic Cholestasis.

Krebs-Schmitt D1, Briem-Richter A1, Brinkert F1, Keitel V2, Pukite I3, Lenhartz H1, Fischer L4, Grabhorn E1.

Abstract

OBJECTIVES:
Bile salt export pump (BSEP) deficiency is an important reason for chronic cholestasis leading to liver transplantation (LT) in early childhood. The underlying pathology is a dysfunction of BSEP due to various mutations in the ABCB11 gene. Cases of clinical recurrence after LT due to alloantibodies directed against BSEP (antibody-induced BSEP deficiency [AIBD]) have been reported. Most of these patients could be controlled by intensified immunosuppression.

METHODS:
We here report on 3 children with BSEP-deficiency and end-stage liver disease, which developed AIBD after LT refractory to extensive immunosuppressive and immunomodulatory treatments; retransplantation was necessary in all 3 patients. In 1 patient, a stem cell transplantation was performed successfully.

RESULTS:
AIBD seems to be induced by triggering factors such as initial impaired graft function or infections after LT.

CONCLUSIONS:
The underlying mutation may play a role in this process. Intensifying immunosuppression may be able to control AIBD, but some cases seem to be refractory to treatment and require retransplantation. Stem cell transplantation may provide a new therapeutic option for cases refractory to conservative treatment.