Feasibility of Monotherapy by Rituximab Without Additional Desensitization in ABO-incompatible Living-Donor Liver Transplantation

Yamamoto, Haruyasu; Uchida, K.; Kawabata, Seiichi; Isono, Kaori; Miura, Kiyonori; Hayashida, Shintaro; Oya, Yuki; Sugawara, Yasuhiko; Inomata, Yukihiro

doi:10.1097/tp.0000000000001956

Cited by 24 publications

(23 citation statements)

References 34 publications

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“…In the present study, ABO‐incompatible graft usage in the XS group was higher than in the S group and was more often used in the context of ALF for infants in both the XS and S groups with good outcomes, and no desensitization manipulations were used. Both pediatric and adult ABO‐incompatible LT survival has improved markedly and has become comparable to ABO‐compatible LT on the introduction of rituximab prophylaxis before LT . However, infants are able to accept ABO‐incompatible grafts without desensitization therapy because the immune system is still developing, which can be verified by confirming low levels of anti‐A and anti‐B antibody titers (<1/8).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Liver Transplantation in Small Infants

et al. 2019

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Liver transplantation (LT) for small infants remains challenging because of the demands related to graft selection, surgical technique, and perioperative management. The aim of this study was to evaluate the short‐term and longterm outcomes of LT regarding vascular/biliary complications, renal function, growth, and patient/graft survival in infants ≤3 months compared with those of an age between >3 and 6 months at a single transplant center. A total of 64 infants ≤6 months underwent LT and were divided into 2 groups according to age at LT: those of age ≤3 months (range, 6‐118 days; XS group, n = 37) and those of age >3 to ≤6 months (range, 124‐179 days; S group, n = 27) between 1989 and 2014. Acute liver failure was the main indication for LT in the XS group (n = 31, 84%) versus S (n = 7, 26%). The overall incidence of hepatic artery thrombosis and portal vein thrombosis/stricture were 5.4% and 10.8% in the XS group and 7.4% and 11.1% in the S group, respectively (not significant). The overall incidence of biliary stricture and leakage were 5.4% and 2.7% in the XS group and 3.7% and 3.7% in the S group, respectively (not significant). There was no significant difference between the 2 groups in terms of renal function. No significant difference was found between the 2 groups for each year after LT in terms of height and weight z score. The 1‐, 5‐, and 10‐year patient survival rates were 70.3%, 70.3%, and 70.3% in the XS group compared with 92.6%, 88.9%, and 88.9% in the S group, respectively (not significant). In conclusion, LT for smaller infants has acceptable outcomes despite the challenges of surgical technique, including vascular reconstruction and graft preparation, and perioperative management.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Liver Transplantation in Small Infants

et al. 2019

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“…Based on this policy, we have used a protocol based on the administration of rituximab (patients who were 2 years or older), tacrolimus, steroids, and MMF without PE, local infusion, and splenectomy since 2010 in ABOi LDLT. 25 …”

Section: Discussionmentioning

confidence: 99%

Long-term Outcomes of ABO-incompatible Pediatric Living Donor Liver Transplantation

et al. 2018

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BackgroundABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been performed to compensate for donor shortage. To date, few studies have reported detailed B-cell desensitization protocols and long-term outcomes of ABOi pediatric LDLT.MethodsTwenty-nine pediatric ABOi LDLT recipients were retrospectively analyzed. We compared the clinical outcomes between ABOi (n = 29) and non-ABOi (n = 131) pediatric LDLT recipients. Furthermore, we evaluated the safety and efficacy of our rituximab-based regimen for ABOi pediatric LDLT (2 ≤ age < 18; n = 10).ResultsThere were no significant differences in the incidence of infection, vascular complications, biliary complications, and acute cellular rejection between ABOi and non-ABOi groups. The cumulative graft survival rate at 1, 3, and 5 years for non-ABOi group were 92.1%, 87.0%, and 86.1%, and those for ABOi group were 82.8%, 82.8%, and 78.2%, respectively. Rituximab-based desensitization protocol could be performed safely, and reduced CD19+ lymphocyte counts effectively. Although rituximab-treated ABOi group showed comparable clinical outcomes and graft survival rate, 2 patients developed antibody-mediated rejection.ConclusionsABOi LDLT is a feasible option for pediatric end-stage liver disease patients. However, it should be noted that current desensitization protocol does not completely prevent the onset of antibody-mediated rejection in several cases.

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“…16 It has been previously reported that the target of pre-transplant antibody ABO-titer values following plasmapheresis were less than 1:8, 1:16, 1:32 or 1:64 to prevent posttransplant AMR. 14 The target titer differs markedly by center and a standard target titer has not yet been established.…”

Section: Plasmapheresis or Total Plasma Exchangementioning

confidence: 99%

“…24 Since the rituximab era, many centers are now trying to simplify the protocol, and avoid splenectomy, local graft infusion, IVIG, and plasmapheresis. [14][15][16][17][18][19][20]…”

Section: Rituximabmentioning

confidence: 99%

Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation

Kim

2020

Clin Mol Hepatol

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In the past, adult ABO incompatible living donor liver transplantation (ABO-I LDLT) had poor graft survival and low patient survival due to hyperacute rejection and a high risk of vascular biliary complication, and it was considered a contraindication. 1-4 Susceptibility to rejection, including severe hepatic necrosis and diffuse intravascular coagulation disorder within the graft, appears to be due to the blood group antigen expressed in the vascular endothelium and bile ducts after transplantation. 5,6 Various desensitization strategies have been introduced to overcome the barrier of ABO incompatibility. 7-9 However, desensitization protocols differ at each center, and the necessity of local infusion, splenectomy, intravenous immunoglobulin (IVIG), and plasmapheresis is controversial. After the rituximab era, the outcome of ABO-I LDLT has been reported in many studies to be comparable to ABO compatible living donor liver transplantation (ABO-C LDLT). 10-13 Many centers are now trying to simplify protocols. 14-20 We review the past and current immune strategies for desensitization and to provide outcomes and ABO incompatibility-related complications in ABO-I LDLT.

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Feasibility of Monotherapy by Rituximab Without Additional Desensitization in ABO-incompatible Living-Donor Liver Transplantation

Abstract: Pretransplant rituximab without additional treatments yielded satisfactory outcomes comparable to that with additional treatments, such as PP and LI.

Cited by 24 publications

References 34 publications

Outcomes of Liver Transplantation in Small Infants

Outcomes of Liver Transplantation in Small Infants

Long-term Outcomes of ABO-incompatible Pediatric Living Donor Liver Transplantation

Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation

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