Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: a Japanese multicenter study.

Abstract

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. Patients underwent dual or triple immunosuppression with or without B cell desensitization therapies such as plasmapheresis, splenectomy, local infusion, intravenous immunoglobulin and rituximab. Era before 2005, intensive care unit-bound status, high Model for End-Stage Liver Disease score and absence of rituximab prophylaxis were significant risk factors for overall survival and antibody-mediated rejection (AMR) in the univariate analysis. After adjustment for era effects in the multivariate analysis, only absence of rituximab prophylaxis was a significant risk factor for AMR, and there were no significant risk factors for survival. Rituximab prophylaxis significantly decreased the incidence of AMR, especially hepatic necrosis (p < 0.001). In the rituximab group, other B cell desensitization therapies had no add-on effects. Multiple or large rituximab doses significantly increased the incidence of infection, and early administration had no advantage. In conclusion, outcomes in adult ABO-I LDLT have significantly improved in the latest era coincident with the introduction of rituximab.

• Authors: H Egawa, S Teramukai, H Haga, M Tanabe, A Mori, T Ikegami, N Kawagishi, H Ohdan, M Kasahara, K Umeshita
• Journal: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (Am J Transplant) Vol. 14 Issue 1 Pg. 102-14 (Jan 2014) ISSN: 1600-6143 [Electronic] United States
• PMID: 24279828 (Publication Type: Journal Article)
• Copyright: © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

Chemical References

• ABO Blood-Group System
• Antibodies, Monoclonal, Murine-Derived
• Immunoglobulins, Intravenous
• Rituximab

Topics

• ABO Blood-Group System (immunology)
• Adolescent
• Adult
• Aged
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, therapeutic use)
• Bacterial Infections (epidemiology)
• Blood Group Incompatibility (drug therapy)
• Desensitization, Immunologic (methods)
• Female
• Graft Rejection (prevention & control)
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Immunosuppression Therapy
• Japan (epidemiology)
• Liver Transplantation (adverse effects, methods)
• Living Donors
• Male
• Middle Aged
• Mycoses (epidemiology)
• Rituximab
• Survival Analysis
• Treatment Outcome