ABO-Incompatible Adult Liver Transplantation When the Anti-ABO Antibody Titer is High

被引：0

作者：

Shimoda, Masafumi ^{[1
]}

Marubashi, Shigeru ^{[1
]}

Dono, Keizo ^{[1
]}

Miyamoto, Atsushi ^{[1
]}

Takeda, Yutaka ^{[1
]}

Umeshita, Koji ^{[1
]}

Nagano, Hiroaki ^{[1
]}

Hoshida, Yoshihiko ^{[2
]}

Monden, Morito ^{[1
]}

机构：

[1] Osaka Univ, Grad Sch Med, Dept Surg, Suita, Osaka 5650871, Japan

[2] Osaka Univ, Grad Sch Med, Dept Pathol, Suita, Osaka 5650871, Japan

来源：

HEPATO-GASTROENTEROLOGY | 2009年 / 56卷 / 93期

关键词：

Blood group incompatibility; Plasmapheresis; Rituximab; Splenectomy; QUADRUPLE IMMUNOSUPPRESSION; MONOCLONAL-ANTIBODY; HUMORAL REJECTION; SPLENECTOMY; RITUXIMAB; INFUSION; CELLS;

D O I：

暂无

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

In comparison with ABO-compatible cases, ABO-incompatible liver transplantation has an increased risk of humoral rejection. The risk factors are the recipient's age (>= 16 years) and elevated titers of anti-donor blood group antibodies. We report a case of adult A-to-O liver transplantation in which the recipient's preoperative IgG titer was 1:8192. Plasmapheresis, splenectomy, rituximab administration, and liver-directed anticoagulation therapy in addition to conventional immunosuppression effectively suppressed the antibody titer, thereby preventing humoral rejection. Preoperative administration of rituximab alone had minimal impact on antibody production, and a substantial amount of plasma cells remained in the spleen. This result is encouraging for high-risk ABO-incompatible liver transplantation and we recommend splenectomy combined with rituximab administration for such cases. Additionally, postoperative modulation of the recipient's immunity to the ABO-incompatible graft was noted, which is necessary for long-term survival of an ABO-mismatched allograft.

引用

页码：1174 / 1177

页数：4

共 17 条

[1]

DEMETRIS AJ, 1988, AM J PATHOL, V132, P489

[2] Impact of recipient age in outcome of ABO-incompatible living-donor liver transplantation [J].

Egawa, H ;

Oike, F ;

Buhler, L ;

Shapiro, AMJ ;

Minamiguchi, S ;

Haga, H ;

Uryuhara, K ;

Kiuchi, T ;

Kaihara, S ;

Tanaka, K .

TRANSPLANTATION, 2004, 77 (03) :403-411

[3] THE USE OF ABO-INCOMPATIBLE GRAFTS IN LIVER-TRANSPLANTATION - A LIFESAVING PROCEDURE IN HIGHLY SELECTED PATIENTS [J].

FARGES, O ;

KALIL, AN ;

SAMUEL, D ;

SALIBA, F ;

ARULNADEN, JL ;

DEBAT, P ;

BISMUTH, A ;

CASTAING, D ;

BISMUTH, H .

TRANSPLANTATION, 1995, 59 (08) :1124-1133

[4] A comparison of splenectomy versus intensive posttransplant antidonor blood group antibody monitoring without splenectomy in ABO-incompatible kidney transplantation [J].

Gloor, JM ;

Lager, DJ ;

Fidler, ME ;

Grande, JP ;

Moore, SB ;

Winters, JL ;

Kremers, WK ;

Stegall, MD .

TRANSPLANTATION, 2005, 80 (11) :1572-1577

[5] Acute humoral rejection and C4d immunostaining in ABO blood-type incompatible liver transplantation [J].

Haga, H ;

Egawa, H ;

Fujimoto, Y ;

Ueda, M ;

Miyagawa-Hayashino, A ;

Sakurai, T ;

Okuno, T ;

Koyanagi, I ;

Takada, Y ;

Manabe, T .

LIVER TRANSPLANTATION, 2006, 12 (03) :457-464

[6] Periportal edema and necrosis as diagnostic histological features of early humoral rejection in ABO-incompatible liver transplantation [J].

Haga, H ;

Egawa, H ;

Shirase, T ;

Miyagawa, A ;

Sakurai, T ;

Minamiguchi, S ;

Yamabe, H ;

Manabe, T ;

Tanaka, K .

LIVER TRANSPLANTATION, 2004, 10 (01) :16-27

[7] ABO-incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: Evidence for accommodation [J].

Hanto, DW ;

Fecteau, AH ;

Alonso, MH ;

Valente, JF ;

Whiting, JF .

LIVER TRANSPLANTATION, 2003, 9 (01) :22-30

[8] Rituximab with plasmapheresis and splenectomy in ABO-incompatible liver transplantation [J].

Monteiro, I ;

McLoughlin, LM ;

Fisher, A ;

De la Torre, AN ;

Koneru, B .

TRANSPLANTATION, 2003, 76 (11) :1648-1649

[9]

NONAMI T, 1992, HEPATOLOGY, V16, P1195, DOI 10.1016/0270-9139(92)90014-Z

[10]

REFF ME, 1994, BLOOD, V83, P435

← 1 2 →