抄録
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.
| 元の言語 | 英語 |
|---|---|
| ページ（範囲） | 102-114 |
| ページ数 | 13 |
| ジャーナル | American Journal of Transplantation |
| 巻 | 14 |
| 発行部数 | 1 |
| DOI | |
| 出版物ステータス | 出版済み - 1 1 2014 |
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All Science Journal Classification (ASJC) codes
- Transplantation
- Immunology and Allergy
- Pharmacology (medical)
これを引用
Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation : A japanese multicenter study. / Egawa, H.; Teramukai, S.; Haga, H.; Tanabe, M.; Mori, A.; Ikegami, Toru; Kawagishi, N.; Ohdan, H.; Kasahara, M.; Umeshita, K.
：: American Journal of Transplantation, 巻 14, 番号 1, 01.01.2014, p. 102-114.研究成果: ジャーナルへの寄稿 › 記事
}
TY - JOUR
T1 - Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation
T2 - A japanese multicenter study
AU - Egawa, H.
AU - Teramukai, S.
AU - Haga, H.
AU - Tanabe, M.
AU - Mori, A.
AU - Ikegami, Toru
AU - Kawagishi, N.
AU - Ohdan, H.
AU - Kasahara, M.
AU - Umeshita, K.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84890984300&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84890984300&partnerID=8YFLogxK
U2 - 10.1111/ajt.12520
DO - 10.1111/ajt.12520
M3 - Article
C2 - 24279828
AN - SCOPUS:84890984300
VL - 14
SP - 102
EP - 114
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 1
ER -