ABO-Incompatible Living Donor Liver Transplantation with Reduced Rituximab Dose: A Retrospective Analysis of 65 Patients – Can We Fast-Track Liver Transplant Surgery and Improve Long-Term Survival?

Hsu, Sandy Huey-Jen; Thorat, Ashok; Jeng, Long‐Bin; Li, Ping-Chun; Chen, Te-Hung; Yang, Horng Ren; Poon, Kin Shing

doi:10.12659/aot.923502

Cited by 7 publications

(3 citation statements)

References 32 publications

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“…Our literature review revealed that biliary complications in LDLT range from 10% to 50%. In most of these cases, the complications involve DIHBS or anastomotic stricture, with DIHBS occurring in about 7% to 20% of cases, and anastomotic stricture rate being about 10% to 50% [ 2 , 3 , 6 , 15 – 17 ]. Song et al [ 2 ] reported an overall incidence of ABOi biliary complications, including DIHBS, of around 19.6%, which was significantly higher than the incidence of biliary stricture in the ABOc group (12.0%, P <0.001).…”

Section: Discussionmentioning

confidence: 99%

“…Other effective measures to conquer post-LT B-cell responses have also been published, including monoclonal antibodies that target plasma cells and memory B cells or the complement system. Previous research has indicated the potential utility of including bortezomib and eculizumab, recently introduced proteasome inhibitors, as plasma cell-depleting agents [ 10 , 15 ]. However, future study is needed to prove the efficacy and safety.…”

Section: Discussionmentioning

confidence: 99%

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Can Microscopic Biliary Reconstruction Reduce Biliary Complication Rate in ABO-Incompatible Adult Living Donor Liver Transplantation?

Lin

et al. 2021

Ann Transplant

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Background With the introduction of rituximab, ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been considered a feasible and safe procedure to overcome the shortage of organ donors. However, higher biliary complication rates remain an unresolved problem in the ABOi group. In our center, biliary anastomosis has been done with microscopic biliary reconstruction (MBR), which effectively reduced the biliary complication rate. The aim of the current study was to investigate whether the microscopic approach reduced anastomotic biliary complications in ABOi LDLT. Material/Methods From March 2006 to December 2018, 30 adult ABOi and 60 ABO-compatible (ABOc) LDLT patients were selected from over 1300 recipients through 1: 2 propensity score-matched cohorts. All patients received MBR during the transplantation. Biliary complications included bile leakage and biliary stricture. Patients with diffuse intrahepatic biliary stricture were excluded from analysis. Results Patient characteristics were similar in the 2 groups. There was no in-hospital mortality in the ABOi LDLT. The long-term survival rates of the ABOi patients were comparable to those of the patients that underwent ABOc LDLT (87.1% vs 87.4%, P =0.964). Those in the ABOi group with anastomotic biliary complications were about 40%, which was higher than in the ABOc patients (40% vs 15%, P =0.01). Conclusions Microscopic biliary reconstruction does not help to reduce the high biliary complication rate in ABOi LDLT. Further investigation and identification regarding other risk factors and precautionary measures involving immunologic and adaptation mechanisms are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Can Microscopic Biliary Reconstruction Reduce Biliary Complication Rate in ABO-Incompatible Adult Living Donor Liver Transplantation?

Lin

et al. 2021

Ann Transplant

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“…Fatal infection occurred in 10% of the recipients, and intrahepatic biliary complications in 8%. 33 In this context, rituximab at 200 mg/m 2 was insufficient for desensitization. Furthermore, extreme immunosuppression—due to an increase in the amount and number of immunosuppression drugs other than rituximab to compensate for inadequate B-cell depletion—led to the fatal infections.…”

Section: Current Immunosuppression Protocols For Abo-i Ldlt and Their...mentioning

confidence: 99%

Current Status of ABO-incompatible Liver Transplantation

2022

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By 2014, strategies to prevent antibody-mediated rejection (AMR) after ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) were established in Japan and expanded primarily to Asia, where LDLT is now the predominant form of LT owing to the scarcity of brain-dead donors. A desensitization protocol consisting of rituximab (375 mg/m 2 ), plasma pheresis, tacrolimus, and mycophenolate mofetil before LDLT, followed by standard immunosuppression, is currently the best option in terms of safety and efficacy. Rituximab administration is now known not to increase the risk of hepatocellular carcinoma recurrence, and the feasibility of rituximab for LDLT for acute liver failure and the need for desensitization before LDLT in children older than 1 y have been documented. Strategies are needed to distinguish patients at high risk of AMR from those at low risk and to adjust immunosuppression to prevent both AMR and infection. Specific single-nucleotide polymorphisms in genes encoding Fcγ receptors affecting the cytotoxicity of rituximab on B cells could be useful for adjusting immunosuppression levels to decrease infectious complications. Immunological accommodation after ABO-I transplantation could be provided by immune factors in both the grafts and recipients.

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Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

Connelly‐Smith

Alquist

Aqui

et al. 2023

J of Clinical Apheresis

159

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The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. In the Ninth Edition, the JCA Special Issue Writing Committee has incorporated systematic review and evidence-based approaches in the grading of evidence and categorization of apheresis indications to make recommendations on the use of apheresis in a wide variety of diseases and conditions. This edition has largely maintained the general layout and concept of a fact sheet introduced in the Fourth Edition (2007). Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease or medical condition. The Ninth Edition of the JCA Special Issue comprises 91 fact sheets and

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ABO-Incompatible Living Donor Liver Transplantation with Reduced Rituximab Dose: A Retrospective Analysis of 65 Patients – Can We Fast-Track Liver Transplant Surgery and Improve Long-Term Survival?

Cited by 7 publications

References 32 publications

Can Microscopic Biliary Reconstruction Reduce Biliary Complication Rate in ABO-Incompatible Adult Living Donor Liver Transplantation?

Can Microscopic Biliary Reconstruction Reduce Biliary Complication Rate in ABO-Incompatible Adult Living Donor Liver Transplantation?

Current Status of ABO-incompatible Liver Transplantation

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

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