Rituximab, IVIG, and plasma exchange without graft local infusion treatment: A new protocol in ABO incompatible living donor liver transplantation

Toru Ikegami, Akinobu Taketomi, Yuji Soejima, Tomoharu Yoshizumi, Hideaki Uchiyama, Noboru Harada, Tomohiro Iguchi, Naotaka Hashimoto, Yoshihiko Maehara

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Abstract

BACKGROUND. Although graft local infusion (GLI) treatment via the portal vein or the hepatic artery has been the pivotal strategy in ABO incompatible (ABOi) living donor liver transplantation (LDLT) in Japan, the procedure is associated with a high rate of catheter-associated complications. METHODS. A new ABOi-LDLT protocol has been implemented using rituximab, intravenous immune globulin (IVIG), plasma exchange (PE), and splenectomy, without using GLI, on four patients, since 2007. Three other patients, treated before 2007, received GLI. RESULTS. Three of the four patients with liver cirrhosis received rituximab over 3 weeks before LDLT, followed by PEs and post-LDLT IVIG, resulting in no rebound elevation of the isoagglutinin titers. The remaining patient, with fulminant hepatitis, received rituximab 3 days before the LDLT, resulting in antibody-mediated rejection, successfully treated by IVIG and PE. All four patients that were treated with the new protocol are alive, 26, 8, 6, and 5 months after ABOi-LDLT with normal liver function. Two of the three other patients with GLI, before 2007, had catheter-associated complications, including one graft loss. CONCLUSION. The new ABOi-LDLT protocol using rituximab, IVIG, and PE, without the use of GLI, therefore seems to be a safe and an effective treatment modality.

Original languageEnglish
Pages (from-to)303-307
Number of pages5
JournalTransplantation
Volume88
Issue number3
DOIs
Publication statusPublished - Aug 15 2009

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Plasma Exchange
Living Donors
Intravenous Immunoglobulins
Liver Transplantation
Transplants
Therapeutics
Catheters
Hepatic Artery
Splenectomy
Portal Vein
Rituximab
Liver Cirrhosis
Hepatitis
Japan
Antibodies
Liver

All Science Journal Classification (ASJC) codes

  • Transplantation

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Rituximab, IVIG, and plasma exchange without graft local infusion treatment : A new protocol in ABO incompatible living donor liver transplantation. / Ikegami, Toru; Taketomi, Akinobu; Soejima, Yuji; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Harada, Noboru; Iguchi, Tomohiro; Hashimoto, Naotaka; Maehara, Yoshihiko.

In: Transplantation, Vol. 88, No. 3, 15.08.2009, p. 303-307.

Research output: Contribution to journalArticle

Ikegami, Toru ; Taketomi, Akinobu ; Soejima, Yuji ; Yoshizumi, Tomoharu ; Uchiyama, Hideaki ; Harada, Noboru ; Iguchi, Tomohiro ; Hashimoto, Naotaka ; Maehara, Yoshihiko. / Rituximab, IVIG, and plasma exchange without graft local infusion treatment : A new protocol in ABO incompatible living donor liver transplantation. In: Transplantation. 2009 ; Vol. 88, No. 3. pp. 303-307.
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AU - Uchiyama, Hideaki

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AB - BACKGROUND. Although graft local infusion (GLI) treatment via the portal vein or the hepatic artery has been the pivotal strategy in ABO incompatible (ABOi) living donor liver transplantation (LDLT) in Japan, the procedure is associated with a high rate of catheter-associated complications. METHODS. A new ABOi-LDLT protocol has been implemented using rituximab, intravenous immune globulin (IVIG), plasma exchange (PE), and splenectomy, without using GLI, on four patients, since 2007. Three other patients, treated before 2007, received GLI. RESULTS. Three of the four patients with liver cirrhosis received rituximab over 3 weeks before LDLT, followed by PEs and post-LDLT IVIG, resulting in no rebound elevation of the isoagglutinin titers. The remaining patient, with fulminant hepatitis, received rituximab 3 days before the LDLT, resulting in antibody-mediated rejection, successfully treated by IVIG and PE. All four patients that were treated with the new protocol are alive, 26, 8, 6, and 5 months after ABOi-LDLT with normal liver function. Two of the three other patients with GLI, before 2007, had catheter-associated complications, including one graft loss. CONCLUSION. The new ABOi-LDLT protocol using rituximab, IVIG, and PE, without the use of GLI, therefore seems to be a safe and an effective treatment modality.

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