Section 15. A desensitizing protocol without local graft infusion therapy and splenectomy is a safe and effective method in ABO-incompatible adult LDLT.
BACKGROUND
The use of rituximab (Rit) to prevent antibody-mediated rejection (AMR) of ABO-incompatible (ABOi) adult living donor liver transplants (ALDLTs) has raised questions about the role of local graft infusion therapy (LGIT) and splenectomy (SPN); however, they are still regarded as essential components of the desensitization (DSZ) protocol.


METHODS
The DSZ protocol consisted of plasma exchange and Rit. None of the patients underwent SPN. The patients were divided into two groups. The patients in Group I (n=20) received LGIT via the hepatic artery or portal vein. The patients in Group II (n=100) did not receive LGIT.


RESULTS
One hundred twenty ABOi ALDLTs were performed from November 2008 to June 2012, and there was only one case of operative mortality (0.8%). There was no significant difference in the 3-year patient survival rates between patients receiving ABO-compatible and ABOi ALDLT (88.8% vs. 94.8%; P=0.11). LGIT catheter-related complications occurred in six patients (30.0%). There was no statistically significant difference in the 3-year patient survival rates between the groups (90.0% vs. 95.0%; P=0.26). One patient in Group 1 (0.8%) experienced AMR. Diffuse intrahepatic biliary stricture occurred in two patients (10.0%) in Group I and in five patients (5.0%) in Group II, although the difference was not statistically significant (P=0.11). The incidence of biliary stricture was similar in both groups (P=0.06), but the incidence of infection was significantly higher in Group I (P=0.03).


CONCLUSIONS
The DSZ protocol without LGIT and splenectomy is a safe and effective method of attaining a successful outcome of ABOi ALDLT.
1 Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. 2 Address correspondence to: Sung-Gyu Lee, M.D., F.A.C.S., 388-1 Pungnab2-dong, Songpa-gu, Seoul, Korea.
Gi-Won
GW
Song
Sung-Gyu
SG
Lee
Shin
S
Hwang
Chul-Soo
CS
Ahn
Ki-Hun
KH
Kim
Deok-Bog
DB
Moon
Tae-Yong
TY
Ha
Dong-Hwan
DH
Jung
Gil-Chun
GC
Park
Hyung-Woo
HW
Park
Yo-Han
YH
Park
Sung-Hwa
SH
Kang
Bo-Hyun
BH
Jung
D000017:ABO Blood-Group System / Q000276:immunology*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage* / Q000009:adverse effects; D001787:Blood Group Incompatibility / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003888:Desensitization, Immunologic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival / Q000187:drug effects*; D006499:Hepatic Artery; D006648:Histocompatibility; D006650:Histocompatibility Testing; D017052:Hospital Mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000009:adverse effects / Q000401:mortality; D011169:Portal Vein; D012307:Risk Factors; D000069283:Rituximab; D013156:Splenectomy / Q000009:adverse effects / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab