title: ABO-incompatible adult liver transplantation when the anti-ABO antibody titer is high.
abstract: 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.
authors.affiliation: Department of Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Shimoda
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Keizo
authors.initials: K
authors.lastname: Dono
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Hoshida
authors.forename: Morito
authors.initials: M
authors.lastname: Monden
mesh_terms: 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
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000925:Anticoagulants; D007074:Immunoglobulin G; D000069283:Rituximab