KMID : 0361120230370030170
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Korean Journal of Transplantation 2023 Volume.37 No. 3 p.170 ~ p.178
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Factors associated with rituximab-mediated B cell depletion in ABO-incompatible adult living donor liver transplantation
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Hong Suk-Kyun
Lee Kwang-Woong Kim Jae-Yoon Lee Jae-Won Kim Ji-Young Choi Hyun-Hwa Hong Su-Young Lee Jeong-Moo Choi Young-Rok Yi Nam-Joon Suh Kyung-Suk
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Abstract
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Background : Pretransplant therapies such as rituximab and plasmapheresis have led to an increase in ABO-incompatible (ABOi) living donor liver transplantation (LDLT), thus helping to overcome organ shortages. This study evaluated the changes in anti-A/B titers and CD19 levels over time in patients undergoing ABOi LT and aimed to understand the effect of single-nucleotide polymorphisms (SNPs) in Fc gamma receptor (Fc¥ãR) on rituximab therapy.
Methods : Two SNPs of FCGR2A (131H/R) and FCGR3A (158F/V) were identified. The clinical data on 44 patients who underwent ABOi LDLT between May 2019 and October 2021 at Seoul National University Hospital were reviewed retrospectively.
Results : Following desensitization with rituximab and subsequent LDLT, the anti-A/B titer recovered within 1 week, but decreased thereafter. The CD19 level increased at 3 months after LT. The genotyping data for FCGR3A (158F/V) indicated that two patients had the V/V genotype, and 42 had the F/V genotype. In the genotyping data for FCGR2A (131H/R), 21 patients had the H/H genotype, three had the R/R genotype, and 20 had the H/R genotype. However, there were no significant differences in anti-A/B and CD19 levels, bacteremia rates, T cell-mediated rejection, antibody-mediated rejection, or the survival rate among the FCGR2A types.
Conclusions : There were significant changes in the anti-A/B titers and CD19 levels over time in each patient after ABOi LDLT. The difference in outcomes following LT according to the Fc¥ãR SNP type for rituximab was unclear. Further studies with larger sample sizes are needed to confirm the effect of Fc¥ãR SNPs on rituximab therapy.
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KEYWORD
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Liver transplantation, ABO blood-group system, Rituximab, Polymorphism
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