Single-Center Experience of ABO-Incompatible Living-Donor Liver Transplantation With a New Simplified Intravenous Immunoglobulin Protocol: A Propensity Score-Matching Analysis

Kim, J.D.; Choi, Dong Lak; Kim, S.-G.; Lee, A-Jin

doi:10.1016/j.transproceed.2016.02.040

Cited by 13 publications

(16 citation statements)

References 18 publications

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“…All studies included in this meta-analysis showed a Newcastle-Ottawa Scale (NOS) score ≥ 6. Four case or propensity score matched studies were included[ 29 , 30 , 35 , 41 ]. Quality assessments of included cohort studies are presented in Table 2 .…”

Section: Resultsmentioning

confidence: 99%

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis

Lee

Kim

Park

2017

WJG

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AIMTo evaluate the differences in outcomes between ABO-incompatible (ABO-I) liver transplantation (LT) and ABO-compatible (ABO-C) LT.METHODSA systematic review and meta-analysis were performed by searching eligible articles published before No-vember 28, 2016 on MEDLINE (PubMed), EMBASE, and Cochrane databases. The primary endpoints were graft survival, patient survival, and ABO-I-related complications.RESULTSTwenty-one retrospective observational studies with a total of 8247 patients were included in this meta-analysis. Pooled results of patient survival for ABO-I LT were comparable to those for ABO-C LT. However, ABO-I LT showed a poorer graft survival than ABO-C LT (1-year: OR = 0.66, 95%CI: 0.57-0.76, P < 0.001; 3-year: OR = 0.74, 95% CI 0.64-0.85, P < 0.001; 5-yearr: OR =0.75, 95%CI: 0.66-0.86, P < 0.001). Furthermore, ABO-I LT was associated with more incidences of antibody-mediated rejection (OR = 74.21, 95%CI: 16.32- 337.45, P < 0.001), chronic rejection (OR =2.28, 95%CI: 1.00-5.22, P = 0.05), cytomegalovirus infection (OR = 2.64, 95%CI: 1.63-4.29, P < 0.001), overall biliary complication (OR = 1.52, 95%CI: 1.01-2.28, P = 0.04), and hepatic artery complication (OR = 4.17, 95%CI: 2.26-7.67, P < 0.001) than ABO-C LT. In subgroup analyses, ABO-I LT and ABO-C LT showed a comparable graft survival in pediatric patients and those using rituximab, and ABO-I LT showed an increased acute cellular rejection in cases involving deceased donor grafts.CONCLUSIONAlthough patient survival in ABO-I LT was comparable to that in ABO-C LT, ABO-I LT was inferior to ABO-C LT in graft survival and several complications. Graft survival of ABO-I LT could be comparable to that of ABO-C LT in pediatric patients and those using rituximab.

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Section: Resultsmentioning

confidence: 99%

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis

Lee

Kim

Park

2017

WJG

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“…It has been proposed to include the blocking of Fc receptors to non-nuclear cells, direct antibody neutralization, suppression of CD19 presentation to activated B cells, suppression of complements, and suppression of all porous T cells. [17][18][19] Several previous studies have reported on the effectiveness of additional IVIG for preventing AMR. Kim et al had reported that the combination of rituximab, plasmapheresis, and IVIG had excellent results.…”

Section: Ivigmentioning

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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“…Rituximab is given for 3 d[ 93 ], 3 wk, or even as soon as a suitable donor that is ABO-compatible is selected[ 94 ] at a dosage of 375 mg/m 2 . In the early stage of transplantation, rituximab was usually given along with one or more other protocols, such as a splenectomy[ 95 , 96 ], plasma exchanges[ 97 - 102 ], intravenous IgG[ 100 , 103 ], and intrahepatic arterial infusion of prostaglandin E1[ 92 , 104 , 105 ]. In some recent studies, pre-transplant rituximab and/or basiliximab monotherapy, without additional treatments, also yielded outcomes that are comparable to those of procedures with additional treatments[ 106 ].…”

Section: Abo-incompatible Ldltmentioning

confidence: 99%

Feasibility of using marginal liver grafts in living donor liver transplantation

Xiang

Zhang

et al. 2018

WJG

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Liver transplantation (LT) is one of the most effective treatments for end-stage liver disease caused by related risk factors when liver resection is contraindicated. Additionally, despite the decrease in the prevalence of hepatitis B virus (HBV) over the past two decades, the absolute number of HBsAg-positive people has increased, leading to an increase in HBV-related liver cirrhosis and hepatocellular carcinoma. Consequently, a large demand exists for LT. While the wait time for patients on the donor list is, to some degree, shorter due to the development of living donor liver transplantation (LDLT), there is still a shortage of liver grafts. Furthermore, recipients often suffer from emergent conditions, such as liver dysfunction or even hepatic encephalopathy, which can lead to a limited choice in grafts. To expand the pool of available liver grafts, one option is the use of organs that were previously considered “unusable” by many, which are often labeled “marginal” organs. Many previous studies have reported on the possibilities of using marginal grafts in orthotopic LT; however, there is still a lack of discussion on this topic, especially regarding the feasibility of using marginal grafts in LDLT. Therefore, the present review aimed to summarize the feasibility of using marginal liver grafts for LDLT and discuss the possibility of expanding the application of these grafts.

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Single-Center Experience of ABO-Incompatible Living-Donor Liver Transplantation With a New Simplified Intravenous Immunoglobulin Protocol: A Propensity Score-Matching Analysis

Cited by 13 publications

References 18 publications

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis

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

Feasibility of using marginal liver grafts in living donor liver transplantation

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