Ann Hepatobiliary Pancreat Surg.  2019 Aug;23(3):211-218. 10.14701/ahbps.2019.23.3.211.

ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer

• Lee B
• Choi Y
• Han HS
• Yoon YS
• Cho JY
• Jeong SH
• Kim JW
• Jang ES
• Ahn S

• KMID: 2456017
• DOI: http://doi.org/10.14701/ahbps.2019.23.3.211

Abstract

BACKGROUNDS/AIMS
Graft survival after ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has increased due to advances in desensitization methods. We analyzed early outcomes following ABOi LDLT using only rituximab without any additional desensitization methods in recipients with low anti-ABO antibody titers (≤1:32).
METHODS
Ten adult patients underwent ABOi LDLT between September 2014 and December 2016. All patients were administered a single dose of rituximab (300 mg/m2) prior to LDLT. Three patients with baseline anti-ABO titer >1:32 underwent multiple sessions of plasmapheresis to reduce titers to <1:32 (rituximab+plasmapheresis, RP). Seven patients with low anti-ABO titer (≤1:32) did not undergo plasmapheresis (rituximab-only, RO). ABO-compatible LDLT patients during the same period were included for comparison (n=22).
RESULTS
Post-transplantation titers were significantly lower in the 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 vs 108±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 ABOi LDLT using conventional immunosuppression and rituximab alone.

Keyword

Antibody mediated rejection; Anti-ABO antibody titer; Plasmapheresis; Rituximab; Liver transplant

MeSH Terms

Adult
Graft Survival
Humans
Immunosuppression
Liver Transplantation*
Liver*
Living Donors
Plasmapheresis
Rituximab*
Rituximab

Figure

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  Fig. 1 Protocol for ABO-incompatible living donor liver transplantation. LT, liver transplantation; SNUBH, Seoul National University Bundang Hospital.

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  Fig. 2 Changes in the CD19+lymphocyte count in ABOi adult LDLT. ABOi, ABO-incompatible; LDLT, living donor liver transplantation; RO, Rituximab only; RP, Rituximab+Plasmapheresis; LT, Liver transplantation.

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  Fig. 3 Changes in the Anti-ABO antibody titer in ABOi adult LDLT. ABOi, ABO-incompatible; LDLT, living donor liver transplantation; RO, Rituximab only; RP, Rituximab+Plasmain the RO group (p=0.03). The anti-ABO antibody titer pheresis; LT, Liver transplantation.

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