A simplified protocol using rituximab and immunoglobulin for ABO‐incompatible low‐titre living donor liver transplantation

• Published in: Liver international Vol. 38; no. 5; pp. 932 - 939
• Main Authors: Kim, Seong Hoon, Lee, Eung Chang, Shim, Jae Ryong, Park, Sang Jae
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.05.2018
• Subjects: ABO Blood-Group System; ABO incompatibility; ABO system; Blood Group Incompatibility; Complications; Data processing; Desensitization; Female; Graft rejection; Graft Rejection - drug therapy; Graft Survival; Humans; Immunoglobulins; Immunoglobulins, Intravenous - administration & dosage; Immunosuppressive agents; Immunotherapy; Intravenous administration; Liver; Liver transplantation; Liver Transplantation - adverse effects; Liver Transplantation - mortality; living donor liver transplantation; Living Donors; Logistic Models; Male; Middle Aged; Monoclonal antibodies; Patients; Plasmapheresis; Propensity Score; Rejection; Republic of Korea - epidemiology; Rituximab; Rituximab - administration & dosage; Splenectomy; Stricture; Surgery; Transplantation; Transplantation Conditioning - methods; Republic of Korea; ABO incompatibility; desensitization; living donor liver transplantation; rituximab
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13614

Background & Aims No consensus has been reached regarding optimal treatment strategies for ABO‐incompatible (ABO‐I) living donor liver transplantation (LDLT). We introduce a simplified protocol using rituximab and intravenous immunoglobulin (IVIG). Methods Data were analysed on adult patients who underwent ABO‐I LDLT of which protocol added rituximab (300 mg/m2) before surgery and IVIG (0.8 g/kg) on post‐operative days 1 and 4 to the conventional immunosuppressive regimen used in ABO‐compatible (ABO‐C) LDLT, without plasmapheresis, splenectomy or graft local infusion. The outcomes were compared with those of ABO‐C LDLT by 1:2 propensity score‐matched analysis. Results Consecutive 43 ABO‐I LDLT patients were identified between 2014 and 2016. Before desensitization, the median isoagglutinin titre was 1:8 (range, 1:2‐1:64). The titre was reduced to 4 (range, 0‐16) at the time of LDLT. None showed a rebound rise of isoagglutinin titres. No antibody‐mediated rejection occurred. Biliary stricture was the most common complication with an incidence of 30.2%. A comparator group of 86 ABO‐C LDLT patients were selected. There was no statistical difference in the overall complication rate including acute cellular rejection, biliary complications and infection between ABO‐I and ABO‐C groups. The 3‐year cumulative patient survival rates in the ABO‐I and ABO‐C groups were 82.4% and 85.9% respectively (P = .115). Conclusions A simplified protocol using rituximab and IVIG for ABO‐I LDLT was safe and effective in achieving sufficient desensitization and comparable outcomes in patients with the titre no higher than 1:64.