ABO-incompatible adult liver transplantation when the anti-ABO antibody titer is high.
In comparison with ABO-compatible cases, ABO-incompatible liver transplantation has an increased risk of humoral rejection. The risk factors are the recipient's age (> or = 16 years) and elevated titers of anti-donor blood group antibodies. We report a case of adult A-to-O liver transplantation in which the recipient's preoperative IgG titer was 1:8192. Plasmapheresis, splenectomy, rituximab administration, and liver-directed anticoagulation therapy in addition to conventional immunosuppression effectively suppressed the antibody titer, thereby preventing humoral rejection. Preoperative administration of rituximab alone had minimal impact on antibody production, and a substantial amount of plasma cells remained in the spleen. This result is encouraging for high-risk ABO-incompatible liver transplantation and we recommend splenectomy combined with rituximab administration for such cases. Additionally, postoperative modulation of the recipient's immunity to the ABO-incompatible graft was noted, which is necessary for long-term survival of an ABO-mismatched allograft.
Shimoda
Masafumi
M
Department of Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Marubashi
Shigeru
S
Dono
Keizo
K
Miyamoto
Atsushi
A
Takeda
Yutaka
Y
Umeshita
Koji
K
Nagano
Hiroaki
H
Hoshida
Yoshihiko
Y
Monden
Morito
M
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000925:Anticoagulants / Q000627:therapeutic use; D001787:Blood Group Incompatibility; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007165:Immunosuppression Therapy; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D012307:Risk Factors; D000069283:Rituximab; D013156:Splenectomy
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000925:Anticoagulants; D007074:Immunoglobulin G; D000069283:Rituximab