The role of immunomodulation in ABO-incompatible adult liver transplant recipients.
BACKGROUND
ABO-incompatible (ABO-i) liver transplantation (LT) is a high-risk procedure due to the potential for antibody-mediated rejection (AMR) and cell-mediated rejection. The aim of the current report is to illustrate the results of a retrospective comparison study on the use of immunomodulation with therapeutic plasma exchange (TPE) associated to high-dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO-i adult LT patients.


METHODS
Between January 1996 and December 2005, 19 patients underwent ABO-i LT. The study was designed for a comparison between two groups of ABO-i LT. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included eight patients treated with TPE and IVIg. Moreover, all Group 2 patients received acute rejection prophylaxis with ECP.


RESULTS
The graft survival at 6, 12, and 18 months was 63.6, 54.4, and 45.5% for Group 1 vs. 87.5, 87.5, and 87.5% for Group 2 (P < or = 0.001). In Group 1 there were 3(27.3%) cases of AMR; 5 (45.4%) biopsy-proven acute rejections (BPAR); 1 (9.1%) chronic rejection and 3 (27.3%) ischemic-type biliary lesions (ITBL). In Group 2 there were no cases of AMR, BPAR, chronic rejection, or ITBL (P = 0.013).


CONCLUSIONS
At median follow-up of 568 days, TPE in combination with IVIg and ECP appears to protect the graft from AMR in ABO-i liver transplantation. Continued patient enrollment will allow validation of these preliminary observations or the opportunity to devise newer AMR-avoidance policies.
Urbani
Lucio
L
Liver Transplant Unit, Azienda Ospedaliero-Universitaria Pisana, Ospedale Cisanello, Pisa, Italy. lucio.urbani.68@alice.it
Mazzoni
Alessandro
A
Bianco
Irene
I
Grazzini
Tiziana
T
De Simone
Paolo
P
Catalano
Gabriele
G
Montin
Umberto
U
Petruccelli
Stefania
S
Morelli
Luca
L
Campani
Daniela
D
Pollina
Luca
L
Biancofiore
Gianni
G
Bindi
Lucia
L
Tascini
Carlo
C
Menichetti
Francesco
F
Scatena
Fabrizio
F
Filipponi
Franco
F
D000017:ABO Blood-Group System; D000328:Adult; D001787:Blood Group Incompatibility; D003131:Combined Modality Therapy; D005260:Female; D006084:Graft Rejection / Q000628:therapy*; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use*; D007155:Immunologic Factors; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D010956:Plasmapheresis; D012189:Retrospective Studies
D000017:ABO Blood-Group System; D007136:Immunoglobulins; D007155:Immunologic Factors