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KMID : 1143920190230030211
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Annals of Hepato-Biliary-Pancreatic Surgery
2019 Volume.23 No. 3 p.211 ~ p.218
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ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer
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Lee Bo-Ram
Choi Young-Rok
Han Ho-Seong
Yoon Yoo-Seok
Cho Jai-Young
Jeong Sook-Hyang
Kim Jin-Wook
Jang Eun-Sun
Ahn Soo-Min
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Abstract
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Backgrounds/Aims: Graft survival after ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has increaseddue to advances in desensitization methods. We analyzed early outcomes following ABOi LDLT using only rituximabwithout any additional desensitization methods in recipients with low anti-ABO antibody titers (≤1:32).
Methods: Tenadult patients underwent ABOi LDLT between September 2014 and December 2016. All patients were administereda single dose of rituximab (300 mg/m2) prior to LDLT. Three patients with baseline anti-ABO titer >1:32 underwentmultiple sessions of plasmapheresis to reduce titers to <1:32 (rituximab+plasmapheresis, RP). Seven patients with lowanti-ABO titer (≤1:32) did not undergo plasmapheresis (rituximab-only, RO). ABO-compatible LDLT patients duringthe same period were included for comparison (n=22).
Results: Post-transplantation titers were significantly lower inthe RO than in the RP and showed no rebound rise (POD7 1.14±0.38 vs 28.0±31.7, p=0.04), (POD30 1.26±0.45 vs108±107, p=0.02). There were no significant differences in rejection, biliary complications and infection between groups.There were no significant differences in outcome between the RO group and ABO-compatible except for infection.
Conclusions: This study shows that recipients with low baseline anti-ABO antibody titer (≤1:32) can undergo ABOiLDLT using conventional immunosuppression and rituximab alone.
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KEYWORD
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Antibody mediated rejection, Anti-ABO antibody titer, Plasmapheresis, Rituximab, Liver transplant
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