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?
| Autor: | Ashok Thorat, Long Bin Jeng, Kin Shing Poon, Te Hung Chen, Ping Chun Li, Shih Chao Hsu, Horng Ren Yang |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Graft Rejection medicine.medical_specialty Time Factors medicine.medical_treatment Intrahepatic bile ducts ABO Blood-Group System End Stage Liver Disease Sepsis hemic and lymphatic diseases ABO blood group system parasitic diseases Living Donors medicine Humans Immunologic Factors Aged Retrospective Studies Original Paper Transplantation business.industry Retrospective cohort study Plasmapheresis General Medicine Middle Aged medicine.disease Tissue Donors Liver Transplantation Surgery Survival Rate Blood Group Incompatibility Cohort Female Rituximab Fast track business medicine.drug |
| Zdroj: | Annals of Transplantation |
| ISSN: | 2329-0358 |
| DOI: | 10.12659/aot.923502 |
| Popis: | BACKGROUND ABO-incompatible (ABO-i) living donor liver transplantation (LDLT) is a feasible alternative for donor liver allograft in emergency situations, especially in Asia, where deceased-donor organs remain scarce. The reported outcomes of ABO-i LDLT after optimal desensitization are comparable to those of ABO-compatible LDLT. In this retrospective study, we found improved outcomes after ABO-i LDLT with a low-dose rituximab in combination with double-filtration plasmapheresis (DFPP) and prophylactic antibiotic therapy. MATERIAL AND METHODS Between January 2006 and December 2018, a total of 65 recipients underwent ABO-i LDLT surgeries at our center. The study cohort consisted of 50 recipients (Era III) who underwent ABO-i LDLT using the recently updated desensitization protocol, which included rituximab 200 mg intravenous injection once a week prior to LDLT, 4 sessions of DFPP in all patients, and prophylactic antibiotics for 3 months. RESULTS The 3-year overall survival rate achieved in ABO-i LDLT patients was 72.7% (66.6% for Era I and 33.3% for Era II patients). In the study population, 11 patients developed complications due to infection. Five of these patients (10%) died due to overwhelming sepsis. Four patients (8%) were diagnosed with multiple strictures and diffusely scattered dilatation of intrahepatic bile ducts on computed tomography, without vascular complications. Three of them had evidence of antibody-mediated rejection (AMR). CONCLUSIONS Our experience shows that the ABO-i LDLT protocol of lowered rituximab combined with pre-transplant sessions of plasmapheresis and a quadruple immunosuppressive regimen can be effective in chronic liver failure patients with clinical urgency in the absence of an ABO-compatible donor. Fast-tracking the use of ABO-i LDLT is feasible in patients with an acute liver failure (ALF) and can safely increase the donor liver pool, with an acceptable outcome. |
| Databáze: | OpenAIRE |
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