Splenectomy Does Not Offer Immunological Benefits in ABO-Incompatible Liver Transplantation With a Preoperative Rituximab

Raut, Vikram; Mori, Akira; Kaido, Toshimi; Ogura, Yasuhiro; Iida, Takuya; Nagai, Kazuyuki; Sasaki, Naoya; Endo, Kazuhira; Hata, Toshiyuki; Yagi, Shintaro; Egawa, Hiroto; Üemoto, Shinji

doi:10.1097/tp.0b013e318239e8e4

Cited by 71 publications

(72 citation statements)

References 34 publications

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“…RIT works by depleting CD20þ from the circulation and lymphoid tissues, thus RIT acts as a form of ''chemical SPL.'' Raut et al (23) found no statistically significant difference in the titers of anti-ABO IgM and IgG antibodies between an SPL group and a non-SPL group. Toki et al (24) studied the impact of low-dose RIT on the splenic B cell population in recipients of ABOi kidney transplantation and reported the near-complete depletion of CD20þ from the spleen.…”

Section: Discussionmentioning

confidence: 99%

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

Song

Lee

Hwang

et al. 2016

American Journal of Transplantation

111

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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Section: Discussionmentioning

confidence: 99%

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

Song

Lee

Hwang

et al. 2016

American Journal of Transplantation

111

124

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“…The recent success with these transplants due to aggressive perioperative isoagglutinin-targeting therapy with plasma exchange, splenectomy, and B cell depletion have left no doubt about the injury incurred by the liver. 47,48 In contrast, conventionally, the liver allograft has been thought to be relatively spared from the effects of preexisting HLA antibodies. Over the years, several mechanisms for this immune privilege have been postulated (Fig.…”

Section: Possible Mechanism Of Donor-specific Human Leukocyte Antigenmentioning

confidence: 97%

Antibody-mediated rejection in liver transplantation: Current controversies and future directions

2014

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“…Earlier studies had reported increased risk of humoral and cellular rejection, arterial thrombosis and biliary complications after ABO incompatible liver transplants (ABOiLT) [53] . Measures such as peri-operative plasmapheresis [54] , and rituximab [55] have been used to lower peri-operative recipient antibody levels and thereby decrease the risk of these complications. ABOiLT in the pediatric population has been used more frequently and outcomes similar to ABO compatible LT have been achieved [56] .…”

Section: Abo Incompatible Liver Transplantsmentioning

confidence: 99%

Matching donor to recipient in liver transplantation: Relevance in clinical practice

Reddy¹,

Varghese²,

Venkataraman³

et al. 2013

WJH

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Achieving optimum outcomes after liver transplantation requires an understanding of the interaction between donor, graft and recipient factors. Within the cohort of patients waiting for a transplant, better matching of the donor organ to the recipient will improve transplant outcomes and benefit the overall waiting list by minimizing graft failure and need for re-transplantation. A PubMed search was conducted to identify published literature investigating the effects of donor factors such as age, gender, ethnicity, viral serology; graft factors such as size and quality, recipient factors such as age, size, gender and transplant factors such as major or minor blood group incompatibility and immunological factors. We also report technical and therapeutic modifications that can be used to manage donor-recipient mismatch identified from literature and the authors' clinical experience. Multiple donor and recipient factors impact graft survival after liver transplantation. Appropriate matching based on donor-organ-recipient variables, modification of surgical technique and innovative peri-transplant strategies can increase the donor pool by utilizing grafts from marginal donors that are traditionally turned down.

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Splenectomy Does Not Offer Immunological Benefits in ABO-Incompatible Liver Transplantation With a Preoperative Rituximab

Abstract: Preoperative rituximab effectively decreased the anti-ABO antibodies sufficiently to prevent the AMR irrespective of splenectomy. Splenectomy does not offer any immunological benefit in ABO-I LT with preoperative rituximab.

Cited by 71 publications

References 34 publications

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

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

Antibody-mediated rejection in liver transplantation: Current controversies and future directions

Matching donor to recipient in liver transplantation: Relevance in clinical practice

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