ABO-Incompatible Adult Living Donor Liver Transplantation Under the Desensitization Protocol With Rituximab

被引：108

作者：

Song, G. -W. ^{[1
]}

Lee, S. -G. ^{[1
]}

Hwang, S. ^{[1
]}

Kim, K. -H. ^{[1
]}

Ahn, C. -S. ^{[1
]}

Moon, D. -B. ^{[1
]}

Ha, T. -Y. ^{[1
]}

Jung, D. -H. ^{[1
]}

Park, G. -C. ^{[1
]}

Kim, W. -J. ^{[1
]}

Sin, M. -H. ^{[1
]}

Yoon, Y. -I. ^{[1
]}

Kang, W. -H. ^{[1
]}

Kim, S. -H. ^{[1
]}

Tak, E. -Y. ^{[2
]}

机构：

[1] Univ Ulsan, Coll Med, Asan Med Ctr, Dept Surg,Div Liver Transplantat & Hepatobiliary, Seoul, South Korea

[2] Univ Ulsan, Coll Med, Asan Med Ctr, Asan Ctr Life Sci, Seoul, South Korea

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2016年 / 16卷 / 01期

关键词：

ANTIBODY-MEDIATED REJECTION; ANTI-CD20; MONOCLONAL-ANTIBODY; BLOOD-GROUP BARRIERS; PLASMA-EXCHANGE; HUMORAL REJECTION; PROTEASOME INHIBITION; ISOAGGLUTININ TITERS; INFUSION THERAPY; SPLENECTOMY; IMPACT;

D O I：

10.1111/ajt.13444

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

ABO incompatibility is no longer considered a contraindication for adult living donor liver transplantation (ALDLT) due to various strategies to overcome the ABO blood group barrier. We report the largest single center experience of ABO-incompatible (ABOi) ALDLT in 235 adult patients. The desensitization protocol included a single dose of rituximab and total plasma exchange. In addition, local graft infusion therapy, cyclophosphamide, or splenectomy was used for a certain time period, but these treatments were eventually discontinued due to adverse events. There were three cases (1.3%) of in-hospital mortality. The cumulative 3-year graft and patient survival rates were 89.2% and 92.3%, respectively, and were comparable to those of the ABO-compatible group (n = 1301). Despite promising survival outcomes, 17 patients (7.2%) experienced antibody-mediated rejection that manifested as diffuse intrahepatic biliary stricture; six cases required retransplantation, and three patients died. ABOi ALDLT is a feasible method for expanding a living liver donor pool, but the efficacy of the desensitization protocol in targeting B cell immunity should be optimized.

引用

页码：157 / 170

页数：14

共 42 条

[1] C4d immunopositivity is uncommon in ABO-compatible liver allografts, but correlates partially with lymphocytotoxic antibody status [J].