Korean J Transplant.  2021 Oct;35(Supple 1):S128. 10.4285/ATW2021.PO-1190.

ABO-incompatible living donor liver transplantation with a simplified desensitization and immunosuppression protocol: a single center retrospective study

• Lee TB
• Ko H
• Shim JR
• Choi BH
• Yang K
• Ryu JH

• KMID: 2521348
• DOI: http://doi.org/10.4285/ATW2021.PO-1190

Abstract

Background
New desensitization strategies have made ABO-incompatible living donor liver transplantation an attractive option for patients with end-stage liver disease. We aimed to report our experience with 20 consecutive patients who underwent ABO-incompatible living donor liver transplantation using a simple A1 desensitization and immunosuppression regimen.
Methods
We retrospectively analyzed 20 ABO-incompatible living donor liver transplantation cases (August 2015 to July 2019).The ABO-incompatible living donor liver transplantation protocol involved rituximab administration (375 mg/m 2 body surface area) at 2–3 weeks preoperatively, subsequent plasma exchanges (target isoagglutinin titer: ≤1:8), basiliximab administration (20mg on the day of surgery and postoperative day 4), and intravenous immunoglobulin administration (2 g/day from the day of surgery to postoperative day 7). No graft local infusion therapy or splenectomy was performed.
Results
Living donor liver transplantation involved a modified right lobe graft for 18 patients and a right posterior segment graft for one patient. The most common reason for liver transplantation was hepatitis B virus-associated liver cirrhosis (16 patients), and 14 patients had hepatocellular carcinoma. The mean age was 55.4±6.3 years, mean model end-stage liver disease score was 14.7±7.7, and mean graft-to-recipient weight ratio was 1.07%±0.2%. The median initial anti-ABO antibody titers were 1:16 for immunoglobulin M (range, 1:2–1:256) and 1:48 for immunoglobulin G (range, 1:4–1:>2,048). The median number of plasma exchanges was 2 (range, 0–12). No cases involved biopsy-confirmed antibody-mediated rejection. No bacterial or fungal infections were observed. Biliary anastomotic stricture was observed in nine cases.
Conclusions
This ABO-incompatible living donor liver transplantation protocol with rituximab, plasma exchange, low-dose intravenous immunoglobulin, and immunosuppression (equivalent to ABO-compatible living donor liver transplantation) could be a safe and effective way to overcome antibody-mediated rejection and other complications.