Biliary stricture is the only concern in ABO-incompatible adult living donor liver transplantation in the rituximab era
| Autor: | Chul-Soo Ahn, Sung-Gyu Lee, Young-In Yoon, Shin Hwang, Gi-Won Song, Bo-Hyun Jung, Sung-Hwa Kang, Gil-Chun Park, Tae-Yong Ha, Dong-Hwan Jung, Ki-Hum Kim, Nayoung Kim, Deok-Bog Moon |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty medicine.medical_treatment Biliary Tract Diseases Constriction Pathologic Liver transplantation law.invention ABO Blood-Group System Antibodies Monoclonal Murine-Derived Model for End-Stage Liver Disease Liver Function Tests law Risk Factors ABO blood group system medicine Living Donors Humans Immunologic Factors Aged Hepatology medicine.diagnostic_test Bile duct business.industry Incidence Middle Aged Intensive care unit Surgery Liver Transplantation Calcineurin Survival Rate medicine.anatomical_structure Treatment Outcome Blood Group Incompatibility Rituximab Female Liver function tests business medicine.drug Follow-Up Studies |
| Zdroj: | Journal of hepatology. 61(3) |
| ISSN: | 1600-0641 |
| Popis: | With the introduction of rituximab prophylaxis, the survival of ABO-incompatible (ABOi) adult living donor liver transplant (ALDLT) has been strikingly improved due to the decreased incidence of antibody-mediated rejection. However, biliary stricture (BS) related to ABO incompatibility remains an unresolved concern.Excluding 105 dual graft ALDLTs, 1102 ALDLT cases including 142 ABOi recipients were included in this study. The desensitization protocol for overcoming the ABO blood group barrier comprised pretransplant plasma exchange, and rituximab (300-375 mg/m(2) BSA).The mean follow-up period was 34.2 ± 15.4 months. The cumulative graft and patient survival rates were comparable in the two groups. The 1- and 3-year BS-free survival rates of ABOi ALDLT were 81.5 and 79.0%, respectively, lower than those of ABOc ALDLT (87.6 and 85.7%, respectively, p=0.022). In the risk factor analysis, diameter of graft bile duct opening5mm, antecedent acute cellular rejection, and ABO incompatibility were independent risk factors for BS. Diffuse intrahepatic biliary stricture (DIHBS) exclusively occurred in 12 patients (8.5%) receiving ABOi ALDLT. The deaths of 3 patients and 4 cases of re-transplantation were related to DIHBS. Graft and patient survival rates were significantly reduced in ABOi ALDLT recipients with DIHBS. However, we failed to identify any significant risk factors for DIHBS.The incidence of BS in ABOi ALDLT is higher than in ABOc, mainly due to the fact of DIHBS which significantly affected survival outcomes. To predict and prevent DIHBS, we need further studies to identify significant risk factors. |
| Databáze: | OpenAIRE |
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