Preoperative selective desensitization of live donor liver transplant recipients considering the degree of T lymphocyte cross-match titer, model for end-stage liver disease score, and graft liver volume.
Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Geun
0000-0003-2597-1068
G
Hong
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Nam-Joon
0000-0002-5467-425X
NJ
Yi
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Suk-won
0000-0001-6111-9601
SW
Suh
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Tae
0000-0003-3834-7125
T
Yoo
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Hyeyoung
0000-0002-3312-9295
H
Kim
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Min-Su
0000-0002-0707-2969
MS
Park
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
YoungRok
0000-0003-2408-7086
Y
Choi
Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
Kyungbun
K
Lee
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Kwang-Woong
0000-0001-6412-1926
KW
Lee
Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea.
Myoung Hee
0000-0003-1272-2695
MH
Park
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Kyung-Suk
0000-0002-9535-7349
KS
Suh
D000017:ABO Blood-Group System / Q000276:immunology; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D003888:Desensitization, Immunologic / Q000379:methods*; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival / Q000276:immunology*; D006650:Histocompatibility Testing; D006801:Humans; D008099:Liver / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011300:Preoperative Care; D012189:Retrospective Studies; D000069283:Rituximab; D012720:Severity of Illness Index; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*; D066027:Transplant Recipients
D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab
Blood Grouping and Crossmatching; Desensitization; Graft Rejection; Liver Transplantation; Living Donors