The clinical significance of donor-specific antibodies (DSA) against donor-human leukocyte antigen (HLA) occurring before or after liver transplantation (LT) on graft success is unknown. Based on recent LT paediatric case series, this study aims at providing the current consensus. The liver appears less sensitive, as compared with kidney transplantation, to antibody-medium injury caused by the cell activity of Kupffer. DSA(donor-specific antibodies) is more likely to occur in children than adults after liver donation. The HLA class II molecules are more frequently used for the DSA, notably the DQ.

The presence of anti-class IIDSA (Dq/DR) may be related with endothelial damage, T-cell mediated refusal (TCMR), inflammation and fibrosis, and particularly of the IgG3 complementary sub-class. Regular monitoring of DSA post-transplantation in routine practise is not yet suggested, but in selected situations can be highly advantageous.