title: Kinetics of B, T, NK lymphocytes and isoagglutinin titers in ABO incompatible living donor liver transplantation using rituximab and basiliximab.
abstract: BACKGROUND
  The kinetics of isoagglutinin titers and lymphocyte subpopulations including B, T, and natural killer (NK) cells after ABO incompatible (ABO-I) living donor liver transplantation (LDLT) have not been evaluated.
  
  
  METHODS
  From January 2012 to July 2013, consecutive ABO-I LDLT patients were enrolled at the National Cancer Center. Our desensitizing protocol included rituximab, plasma exchanges, basiliximab, and intravenous immune globulin without splenectomy.
  
  
  RESULTS
  Twenty patients (14 males, 6 females) underwent ABO-I LDLT due to HCC (n=15) or liver cirrhosis (n=5). There was no hyperacute and antibody-mediated rejection. The isoagglutinin titers were effectively lowered less than 1:16 before operation. CD 19+ B cells were rapidly eliminated after rituximab and suppressed during 6months postoperatively. CD3+ and CD4+ T cells were elevated higher than CD8+ T cells. CD4/CD8 ratio was increased during first 1month postoperatively and decreased thereafter. CD16+CD56+ NK cells were lowered and restored after 4months of LDLT. Among 15 patients with HCC, 5 patients (33.3%) experienced early tumor recurrence (1/8 within Milan and 4/7 beyond Milan).
  
  
  CONCLUSIONS
  Our protocol showed effective results in preventing antibody-mediated rejection and suppressing B lymphocytes. Application to advanced hepatocellular carcinoma should be considered due to decreased natural immunity after ABO-I LDLT.
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Seung Duk
authors.initials: SD
authors.lastname: Lee
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. Electronic address: kshlj@hanmail.net.
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Sun-Young
authors.initials: SY
authors.lastname: Kong
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea.
authors.forename: Young-Kyu
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D001402:B-Lymphocytes / Q000276:immunology* / Q000378:metabolism; D000077552:Basiliximab; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000276:immunology / Q000628:therapy; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007694:Killer Cells, Natural / Q000276:immunology* / Q000378:metabolism; D007700:Kinetics; D008113:Liver Neoplasms / Q000097:blood / Q000276:immunology / Q000628:therapy; D016031:Liver Transplantation; D019520:Living Donors; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage*; D000069283:Rituximab
chemical_list: D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000069283:Rituximab; D000077552:Basiliximab
keywords: ABO incompatible; Basiliximab; Kinetics; Living donor liver transplantation; Rituximab