Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: A japanese multicenter study

H. Egawa, S. Teramukai, H. Haga, M. Tanabe, A. Mori, T. Ikegami, N. Kawagishi, H. Ohdan, M. Kasahara, K. Umeshita

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Abstract

We evaluated the effects of rituximab prophylaxis on outcomes of ABO-blood-type-incompatible living donor liver transplantation (ABO-I LDLT) in 381 adult patients in the Japanese registry of ABO-I LDLT. Patients underwent dual or triple immunosuppression with or without B cell desensitization therapies such as plasmapheresis, splenectomy, local infusion, intravenous immunoglobulin and rituximab. Era before 2005, intensive care unit-bound status, high Model for End-Stage Liver Disease score and absence of rituximab prophylaxis were significant risk factors for overall survival and antibody-mediated rejection (AMR) in the univariate analysis. After adjustment for era effects in the multivariate analysis, only absence of rituximab prophylaxis was a significant risk factor for AMR, and there were no significant risk factors for survival. Rituximab prophylaxis significantly decreased the incidence of AMR, especially hepatic necrosis (p < 0.001). In the rituximab group, other B cell desensitization therapies had no add-on effects. Multiple or large rituximab doses significantly increased the incidence of infection, and early administration had no advantage. In conclusion, outcomes in adult ABO-I LDLT have significantly improved in the latest era coincident with the introduction of rituximab. This registry study suggests that rituximab prophylaxis contributes to improved outcomes of adult ABO-incompatible living donor liver transplantation.

Original languageEnglish
Pages (from-to)102-114
Number of pages13
JournalAmerican Journal of Transplantation
Volume14
Issue number1
DOIs
Publication statusPublished - Jan 2014

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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    Egawa, H., Teramukai, S., Haga, H., Tanabe, M., Mori, A., Ikegami, T., Kawagishi, N., Ohdan, H., Kasahara, M., & Umeshita, K. (2014). Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: A japanese multicenter study. American Journal of Transplantation, 14(1), 102-114. https://doi.org/10.1111/ajt.12520