A comparison of desensitization methods: Rituximab with/without plasmapheresis in ABO-incompatible living donor liver transplantation

• Published in: Hepatobiliary & pancreatic diseases international Vol. 17; no. 2; pp. 119 - 125
• Main Authors: Lee, Eung Chang, Kim, Seong Hoon, Shim, Jae Ryong, Park, Sang-Jae
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.04.2018; Center for Liver Cancer,National Cancer Center,323 Ilsan-ro,Ilsandong-gu,Goyang-si,Gyeonggi-do 10408,Republic of Korea
• Subjects: ABO-incompatibility; Desensitization; Liver transplantation; Living donor; Plasmapheresis; Rituximab; Rituximab; Desensitization; ABO-incompatibility; Living donor; Plasmapheresis; Liver transplantation
• ISSN: 1499-3872
• DOI: 10.1016/j.hbpd.2018.02.005

Plasmapheresis is a desensitization method used prior to ABO-incompatible (ABO-I) living donor liver transplantation. However, studies on its usefulness in the rituximab era are lacking. Fifty-six adult patients underwent ABO-I living donor liver transplantation between January 2012 and October 2015. A single dose of rituximab (300 mg/m2) was administered 2 weeks before surgery with plasmapheresis in all patients until February 2014 (RP group, n = 26). Patients were administered rituximab only, without plasmapheresis between March 2014 and October 2015 (RO group, n = 30). The 6-, 12- and 18-month overall survival rates were 92.3%, 80.8% and 76.9% in the RP group and 96.6%, 85.4% and 85.4% in the RO group, respectively (P = 0.574). When the initial isoagglutinin titers < 16, neither group showed a rebound rise of isoagglutinin titers. For patients with initial isoagglutinin titers ≥ 16, the rebound rise of isoagglutinin titers was more prominent in the RP group. There was no difference in time-dependent changes in B cell subpopulations and ABO-I-related complications. Sufficient desensitization for ABO-I living donor liver transplantation can be achieved using rituximab alone. This desensitization strategy does not affect the isoagglutinin titers, ABO-I-related complications and patient survival.