The impact of rituximab in ABO-incompatible pediatric living donor liver transplantation: the experience of a single center.

Abstract

Previous studies have demonstrated the safety of ABO-incompatible pediatric LDLT using preoperative plasmapheresis and rituximab; however, no reports have described the timing and dosage of rituximab administration for pediatric LDLT. This study aimed to describe a safe and effective dosage and timing of rituximab for patients undergoing pediatric ABO-incompatible LDLT based on the experience of our single center. A total of 192 LDLTs in 187 patients were examined. These cases included 29 ABO-incompatible LDLTs in 28 patients. Rituximab was used beginning in January 2004 in recipients older than two yr of age (first period: 375 mg/m(2) in two cases; second period: 50 mg/m(2) in two cases; and 200 mg/m(2) in eight cases). Two patients who received 375 mg/m(2) rituximab died of Pneumocystis carinii pneumonia and hemophagocytic syndrome. One patient who received 50 mg/m(2) rituximab required retransplantation as a consequence of antibody-mediated complications. All eight patients administered 200 mg/m(2) survived, and the mean CD20(+) lymphocyte count was 0.1% at the time of LDLT. In the preoperative management of patients undergoing pediatric ABO-incompatible LDLT, the administration of 200 mg/m(2) rituximab three wk prior to LDLT was safe and effective.

• Authors: Noriki Okada, Yukihiro Sanada, Yuta Hirata, Naoya Yamada, Taiichi Wakiya, Yoshiyuki Ihara, Taizen Urahashi, Atsushi Miki, Yuji Kaneda, Hideki Sasanuma, Takehito Fujiwara, Yasunaru Sakuma, Atsushi Shimizu, Masanobu Hyodo, Yoshikazu Yasuda, Koichi Mizuta
• Journal: Pediatric transplantation (Pediatr Transplant) Vol. 19 Issue 3 Pg. 279-86 (May 2015) ISSN: 1399-3046 [Electronic] Denmark
• PMID: 25689881 (Publication Type: Journal Article)
• Copyright: © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• ABO Blood-Group System
• Immunosuppressive Agents
• Rituximab

Topics

• ABO Blood-Group System (immunology)
• Blood Group Incompatibility (immunology)
• Child
• Child, Preschool
• Female
• Graft Survival
• Humans
• Immunosuppressive Agents (therapeutic use)
• Infant
• Liver Failure (surgery)
• Liver Transplantation (methods)
• Living Donors
• Lymphohistiocytosis, Hemophagocytic (diagnosis)
• Male
• Plasmapheresis
• Pneumonia, Pneumocystis (diagnosis)
• Postoperative Period
• Reoperation
• Rituximab (therapeutic use)
• Time Factors
• Treatment Outcome