ABO-Incompatible Liver Transplantation Using only Rituximab for Patients with Low Anti-ABO Antibody Titer

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BackgroundGraft survival after ABO-incompatible living donor liver transplantation (LDLT) has increased due to advances in desensitization methods. We analyzed early outcomes following ABO-incompatible LDLT without plasmapheresis in recipients with low anti-ABO antibody titers (1:32).MethodsTen adult patients underwent ABO-incompatible LDLT between September 2014 and December 2016. All patients were administered a single dose of rituximab (300 mg/m2) prior to LDLT. Three patients with baseline anti-ABO titer >1:32 also underwent multiple sessions of plasmapheresis to reduce titers to 1:32 or lower (rituximab + plasmapheresis, RP). Seven patients with low anti-ABO titer (1:32) did not undergo plasmapheresis (rituximab-only, RO). Adult ABO-compatible LDLT patients during the same period were included for comparison (n=22).ResultsPost-transplantation titers were significantly lower in the RO than in the RP and showed no rebound rise (POD7 1.14±0.38 vs 28.0±31.7, p=0.04), (POD30 1.26±0.45 vs 108±107, p=0.02). There were no significant differences in rejection, biliary complications, or infection between the RO and RP group. There were no significant differences in outcome between the RO group and ABO-compatible except for rate of infection (RO: 57.1%; ABO-compatible: 9.1%; p=0.02).ConclusionsThis study shows that recipients with low baseline anti-ABO antibody titer (≤1:32) can undergo ABO-incompatible LDLT using conventional immunosuppression and rituximab alone.

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