Successful use of anti-CD20 monoclonal antibody (rituximab) for ABO-incompatible living-related liver transplantation.
BACKGROUND
Humoral rejection after ABO-incompatible liver transplantation often causes graft loss and a life-threatening situation. We used rituximab, which can eliminate B cells highly selectively, as an additional therapy for ABO-incompatible living-related liver transplantation.


METHODS
Patient 1 was a 1-year-old girl with biliary atresia. Her blood type was O, and the donor's was A. She underwent two plasma exchanges before liver transplantation and had triple immunosuppressants (mycophenolate mofetil, tacrolimus, and methylprednisolone). She was diagnosed with humoral rejection by needle biopsy on postoperative day 6. Rituximab was used for 3 days at 375, 187, and 187 mg/m(2) and successfully reduced the antibody titer, transaminase, and CD19(+) cells count in peripheral blood lymphocytes. The patient has not had any severe rejection, infection, or serious complications 2 years posttransplantation. Patient 2 was a 42-year-old woman with primary biliary cirrhosis. The blood type was O, and the donor's was B. She received three plasma exchanges, triple immunosuppressants, splenectomy, intraarterial anticoagulant therapy, and rituximab (375 mg/m(2) immediately after transplantation). The titer and CD19(+) cells count remained persistently low throughout the recovery course. She did not develop humoral rejection 1 year after transplantation.


CONCLUSIONS
Rituximab efficiently reduces anti-ABO antibody titer by selectively eliminating B cells and is safe and effective against humoral rejection after ABO-incompatible liver transplantation.
Usuda
Masahiro
M
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan. usu-masa@mail.tains.tohoku.ac.jp
Fujimori
Keisei
K
Koyamada
Nozomi
N
Fukumori
Tatsuya
T
Sekiguchi
Satoshi
S
Kawagishi
Naoki
N
Akamatsu
Yorihiro
Y
Enomoto
Yoshitaka
Y
Satoh
Kazushige
K
Satoh
Akira
A
Ishida
Kazuyuki
K
Moriya
Takuya
T
Satomi
Susumu
S
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology*; D001787:Blood Group Incompatibility; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D000069283:Rituximab
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000069283:Rituximab