Biliary stricture is the only concern in ABO-incompatible adult living donor liver transplantation in the rituximab era

Song, Gi‐Won; Lee, Sung‐Gyu; Hwang, Shin; Kim, Ki-Hum; Ahn, Curie; Ha, Tae‐Yong; Jung, Dong‐Hwan; Park, Gil‐Chun; Kang, Sung-Hwa; Jung, Bo‐Hyun; Yoon, Young‐In; Kim, Nayoung

doi:10.1016/j.jhep.2014.04.039

Cited by 99 publications

(128 citation statements)

References 18 publications

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“…This predictive value was described previously by Raszeja-Wyszomirska et al 25 On the other hand, MELD score is asso- 26 However, no large study regarding the ABO-incompatible deceased liver transplantation in the rituximab era was reported. Our data firstly highlighted the negative impacts of ABO-incompatible DCD liver grafts even when rituximab employed.…”

Section: R E T R a C T E Dsupporting

confidence: 70%

Retraction: “Safety limitations of fatty liver transplantation can be extended to 40%: Experience of a single centre in China”, by Yu Z., Yu S., Zhang L., Feng X., Zhang M., et al.

2016

Liver International

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Background & Aims: Liver transplantation is the only solution for terminal liver disease. This study aims to determine the association between severity of liver graft steatosis, as well as other risk factors, and poor prognosis of liver transplantation. Methods:The degree of steatosis was analysed in 563 consecutive liver transplantation and classified by histological examination as M0 (0%), M1 (<30%), M2-1 (30%-39%), M2-2 (40%-49%), M2-3 (50%-59%) or M3 (≥60%). Recipients were analysed for in-hospital infection, 1-month mortality or graft loss, primary non-function (PNF), biliary complications, acute graft rejection, graft and patient survival. Results:Compared with M0 livers, M1 and M2-1 livers had no negative impacts on prognosis of liver transplantation. ≥40% steatotic livers significantly increased the prevalence of 1-month mortality and PNF, but diminished graft and patient survival time. Conclusions:The safety limitations of fatty liver transplantation can be extended to 40%. K E Y W O R D Snon-alcoholic fatty liver disease, primary non-function, prognosis, steatosis

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Section: R E T R a C T E Dsupporting

confidence: 70%

Retraction: “Safety limitations of fatty liver transplantation can be extended to 40%: Experience of a single centre in China”, by Yu Z., Yu S., Zhang L., Feng X., Zhang M., et al.

2016

Liver International

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“…Consequently, the impact of IA titer on AMR may be masked, and no relationship between IA titer and patient survival or between recipient blood type or mismatch pattern and AMR or patient survival has been found. A recent large multicenter Japanese study by Egawa et al (5) and a single-center study by Song et al (6) failed to prove the impact of IA on AMR. Nevertheless, there is no doubt about the principal role of antidonor ABO IA in the pathophysiology of AMR.…”

Section: Discussionmentioning

confidence: 99%

“…Even though the role of the ABO antibody titer is still not well defined, the general belief is that a higher IA titer may result in a higher risk of AMR (4)(5)(6)17,26).The role of IA titers in the AMR of ABOi LT has been controversial. Mor et al (38) showed a possible link between a high IA titer and AMR, in particular, in A-to-O transplants, whereas Skogsberg et al (39) showed no correlation between a high IA titer and AMR.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, ABOi LT became unpopular and was reserved for urgent LT, particularly for pediatric patients (4). Since the introduction of desensitization (DSZ) with the anti-CD20 monoclonal antibody rituximab (RIT), the risk of hepatic necrosis caused by full-blown AMR has almost disappeared, and overimmunosuppression aimed at avoiding AMR is no longer required (5,6). Nonetheless, most reports on the clinical outcomes of ABOi ALDLT in the literature still include unfavorable outcome data from before the RIT era, leading to overestimation of the morbidity rate and underestimation of the survival rate of current ABOi ALDLT (7).…”

Section: Introductionmentioning

confidence: 99%

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ABO-Incompatible Adult Living Donor Liver Transplantation Under the Desensitization Protocol With Rituximab

Song

Lee

Hwang

et al. 2016

American Journal of Transplantation

113

124

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ABO incompatibility is no longer considered a contraindication for adult living donor liver transplantation (ALDLT) due to various strategies to overcome the ABO blood group barrier. We report the largest singlecenter experience of ABO-incompatible (ABOi) ALDLT in 235 adult patients. The desensitization protocol included a single dose of rituximab and total plasma exchange. In addition, local graft infusion therapy, cyclophosphamide, or splenectomy was used for a certain time period, but these treatments were eventually discontinued due to adverse events. There were three cases (1.3%) of in-hospital mortality. The cumulative 3-year graft and patient survival rates were 89.2% and 92.3%, respectively, and were comparable to those of the ABO-compatible group (n ¼ 1301). Despite promising survival outcomes, 17 patients (7.2%) experienced antibody-mediated rejection that manifested as diffuse intrahepatic biliary stricture; six cases required retransplantation, and three patients died. ABOi ALDLT is a feasible method for expanding a living liver donor pool, but the efficacy of the desensitization protocol in targeting B cell immunity should be optimized.

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“…Immunological factors (e.g., ABO blood type incompatibility [37,38] and cytomegalovirus infection [39]) are also associated with non-BAS formation. Because cholangiocytes play an important role in mucosal immunity in the biliary system [40,41], they are the primary targets of immune attack, which leads to stricture formation.…”

Section: Etiologies and Risk Factors For Biliary Strictures After Ldltmentioning

confidence: 99%

Endoscopic management of biliary strictures after living donor liver transplantation

Tsujino

Isayama

Kogure

et al. 2017

Clin J Gastroenterol

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Living donor liver transplantation (LDLT) is an effective alternative to deceased liver transplantation (DDLT) for end-stage liver disease. Although advances in surgical techniques, immunosuppressive management, and post-transplant care have improved the overall outcomes of LDLT, biliary strictures remain the major unsolved problem. Endoscopic retrograde cholangiopancreatography (ERCP) is currently considered the first-line therapy for biliary strictures following LDLT with duct-to-duct reconstruction, with percutaneous and surgical interventions reserved for patients with unsuccessful management via ERCP. Endoscopic management of biliary strictures is technically more challenging in LDLT than in DDLT because of the complexity of the biliary anastomosis, in addition to the tortuous and angulated biliary system. Placement of one or more plastic stents after balloon dilation has been the standard strategy for post-LDLT stricture, but this requires multiple stent exchange to prevent stent occlusion until stricture resolution. Inside stents might prevent duodenobiliary reflux and thus have longer stent patency, obviating the need for multiple ERCPs. Newly developed covered self-expandable metallic stents with anti-migration systems are alternatives to the placement of multiple plastic stents. With the advent of deep enteroscopy, biliary strictures in LDLT patients with Rouxen-Y hepaticojejunostomy are now treatable endoscopically. In this review, we discuss the short-and long-term outcomes of endoscopic management of post-LDLT strictures as well as recent advances in this field.

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Biliary stricture is the only concern in ABO-incompatible adult living donor liver transplantation in the rituximab era

Cited by 99 publications

References 18 publications

Retraction: “Safety limitations of fatty liver transplantation can be extended to 40%: Experience of a single centre in China”, by Yu Z., Yu S., Zhang L., Feng X., Zhang M., et al.

Retraction: “Safety limitations of fatty liver transplantation can be extended to 40%: Experience of a single centre in China”, by Yu Z., Yu S., Zhang L., Feng X., Zhang M., et al.

ABO-Incompatible Adult Living Donor Liver Transplantation Under the Desensitization Protocol With Rituximab

Endoscopic management of biliary strictures after living donor liver transplantation

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