Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume

Abstract

Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe.Graphical Abstract

Preformed donor‐specific antibodies do not affect the 1‐year allograft survival in living donor liver transplantation

“…These individuals were successfully desensitized in advance of LT because of the administration of premedication (rituximab and several times of plasmapheresis) for ABO‐incompatible situation. There were evidences that the pretransplant desensitization protocol (the same protocol used for ABO‐incompatible LT) used for the highly sensitized patients in LDLT had a good impact on the outcome of LT . Thus, pretransplant desensitization might have positively influenced the outcome in patients with pretransplant DSA (+) and ABO‐incompatible LT in the present study.…”

“…In the case of a scheduled LDLT, we typically have time to prepare for desensitization prior to the LT procedure. If there is evidence of positive lymphocyte cross‐matching or DSA as a risk factor for decreased graft survival of LDLT, premedication for positive lymphocyte cross‐matching or DSA or selection of the other donor can be helpful in LDLT …”

Evaluation of donor workups and exclusions in a single‐center experience of living donor liver transplantation

“…This condition is not considered as a contraindication for liver donation in our center. However, we considered desensitization protocols in patients with a high risk of antibody mediated rejection and with strict follow‐up to screen for the presence of de novo DSA . Furthermore, recently HLA typing has become important to exclude donors.…”

Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation

“…studies of desensitization or treatment, decreasing levels of cytotoxic antibodies and improved allograft function (Table 4) were reported [142,[149][150][151][152][153][154][155] . Well-designed studies on this subject are needed.…”

“…Splenectomy, plasmapheresis, bortezomid Improvement of liver/kidney function; decrease of DSAs'; survived Shindoh et al [154] LDLT n = 1; post-LT, after decrease of platelet count and increase of attacking IgG -Recovery of platelet count; decrease of attacking IgG; survived Leonard et al [137] LT n = 2; post-LT, after liver function deterioration -Recovery of allograft function; survival rate 100% Hong et al [155] LDLT n = 1; post-LT, desensitization -Survived…”