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Presenter: Naoki, Kawagishi, , Japan
Impact of rituximab desensitization on blood-type-incompatible living donor liver transplantation in adults: A Japanese multicenter study
N. Kawagishia, S. Teramukaib, H. Egawac
aDepartment of Surgery, Graduate School of Medicine, Tohoku University, Miyagi, Japan
bInnovative Clinical Research Center, Kanazawa University, Kanazawa, Japan
cDepartment of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan
We evaluated the effects of rituximab prophylaxis on outcomes of ABO-blood-type-incompatible living donor liver transplantation (ABO-I LDLT) in 381 adult patients in the Japanese registry of ABO-I LDLT. All patients underwent triple immunosuppression together with plasmapheresis or splenectomy or both; regimens were classified into 3 groups according to additional treatment: none (Base group, n = 25); local infusion therapy (Infusion group, n = 94); and rituximab prophylaxis (Rituximab group, n = 258). The incidence of antibody-mediated rejection (AMR) was significantly lower in the Rituximab group (6%) than in the Base (28%) or Infusion (22%) group (P < 0.001), and 5-year survival was significantly higher in the Rituximab group (71%) than in the other groups (33%, 51%, respectively; P < 0.001). Among preoperative and short-term postoperative variables, only rituximab prophylaxis was significantly associated with survival time and MELD score. Intraoperative titer of IgG anti-donor antibodies and rituximab prophylaxis were significant predictors of AMR incidence. In the Rituximab group, other B-cell desensitization therapies had no add-on effects. Multiple or large rituximab doses significantly increased infection, and early administration had no advantage. In conclusion, a single moderate dose of rituximab was safe and effective in adult ABO-I LDLT.
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