title: Kinetics of anti-blood type isoagglutinin titers and B lymphocytes in ABO-incompatible living donor liver transplantation with rituximab and plasma exchange.
abstract: BACKGROUND
  A novel immunosuppression protocol using rituximab and plasma exchange treatment was developed for ABO-incompatible living donor liver transplantation (ABO-I LDLT). The aim of this study was to investigate the kinetics of anti-blood type isoagglutinin titers and the number of blood B lymphocytes in ABO-I LDLT with the new protocol and their impact on the outcomes after ABO-I LDLT.
  
  
  METHODS
  Fifteen patients underwent ABO-I LDLT plus splenectomy with the new protocol between November 2005 and December 2010, and their data were retrospectively analyzed.
  
  
  RESULTS
  CD19-positive lymphocytes in the blood rapidly disappeared after rituximab treatment and began to recover approximately 6 months later. Anti-blood type isoagglutinin titers were lowered by pretransplant plasma exchange (2(3)∼2(12)→2(1)∼2(8)). Although the anti-donor blood type isoagglutinin titers remained consistently low after transplantation in comparison to the pretreatment levels, they persisted long after LDLT, whereas posttransplant biopsy specimens showed sustained A/B antigens on the graft livers. ABO-I hepatitis C virus-positive patients were prone to acceleration of hepatitis C viremia and cytomegalovirus antigenemia in comparison to the control patients.
  
  
  CONCLUSIONS
  Although the new protocol for ABO-I LDLT yielded great success with 100% graft survival, the acceptable anti-blood type isoagglutinin titers just before LDLT, and its application to hepatitis C-positive patients must be determined.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. huchi@surg2.med.kyushu-u.ac.jp
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Yohei
authors.initials: Y
authors.lastname: Mano
authors.forename: Akinobu
authors.initials: A
authors.lastname: Taketomi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D000368:Aged; D000373:Agglutinins / Q000097:blood* / Q000502:physiology; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D000956:Antigens, Viral / Q000097:blood; D001402:B-Lymphocytes / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D006526:Hepatitis C / Q000276:immunology; D006801:Humans; D007700:Kinetics; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D012367:RNA, Viral / Q000097:blood; D000069283:Rituximab
chemical_list: D000017:ABO Blood-Group System; D000373:Agglutinins; D058846:Antibodies, Monoclonal, Murine-Derived; D000956:Antigens, Viral; D012367:RNA, Viral; D000069283:Rituximab