title: The impact of rituximab in ABO-incompatible pediatric living donor liver transplantation: the experience of a single center.
abstract: Previous studies have demonstrated the safety of ABO-incompatible pediatric LDLT using preoperative plasmapheresis and rituximab; however, no reports have described the timing and dosage of rituximab administration for pediatric LDLT. This study aimed to describe a safe and effective dosage and timing of rituximab for patients undergoing pediatric ABO-incompatible LDLT based on the experience of our single center. A total of 192 LDLTs in 187 patients were examined. These cases included 29 ABO-incompatible LDLTs in 28 patients. Rituximab was used beginning in January 2004 in recipients older than two yr of age (first period: 375 mg/m(2) in two cases; second period: 50 mg/m(2) in two cases; and 200 mg/m(2) in eight cases). Two patients who received 375 mg/m(2) rituximab died of Pneumocystis carinii pneumonia and hemophagocytic syndrome. One patient who received 50 mg/m(2) rituximab required retransplantation as a consequence of antibody-mediated complications. All eight patients administered 200 mg/m(2) survived, and the mean CD20(+) lymphocyte count was 0.1% at the time of LDLT. In the preoperative management of patients undergoing pediatric ABO-incompatible LDLT, the administration of 200 mg/m(2) rituximab three wk prior to LDLT was safe and effective.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, Shimotsuke-shi, Tochigi-ken, Japan.
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.forename: Yuta
authors.initials: Y
authors.lastname: Hirata
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miki
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kaneda
authors.forename: Hideki
authors.initials: H
authors.lastname: Sasanuma
authors.forename: Takehito
authors.initials: T
authors.lastname: Fujiwara
authors.forename: Yasunaru
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shimizu
authors.forename: Masanobu
authors.initials: M
authors.lastname: Hyodo
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Yasuda
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007223:Infant; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis; D008297:Male; D010956:Plasmapheresis; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis; D011184:Postoperative Period; D012086:Reoperation; D000069283:Rituximab / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents; D000069283:Rituximab
keywords: ABO-incompatibility; living donor liver transplantation; pediatric transplantation; rituximab