Feasibility of Monotherapy by Rituximab Without Additional Desensitization in ABO-incompatible Living-Donor Liver Transplantation
Feasibility of Monotherapy by Rituximab Without Additional Desensitization in ABO-incompatible Living-Donor Liver Transplantation
复制标题
DOI：
10.1097/tp.0000000000001956
复制
发表时间：
2018
期刊：
影响因子：
6.2
通讯作者：
Hidekazu Yamamoto;K. Uchida;S. Kawabata;K. Isono;K. Miura;S. Hayashida;Y. Oya;Y. Sugawara;Y. Inomata
中科院分区：
文献类型：
--
作者：
Hidekazu Yamamoto;K. Uchida;S. Kawabata;K. Isono;K. Miura;S. Hayashida;Y. Oya;Y. Sugawara;Y. Inomata
背景利妥昔单抗是ABO血型不合活体肝移植（ABO-i LDLT）脱敏方案的基石，使这种方式成为肝移植的可接受选择。血浆置换（PP）降低抗ABO抗体滴度和局部输注（LI）治疗被用作利妥昔单抗应用前的脱敏策略，并被报告为额外治疗。本研究的目的是澄清利妥昔单抗单药治疗的可行性，没有任何额外的脱敏治疗ABO-i LT。方法40例患者接受ABO-i LDLT与利妥昔单抗入组这项回顾性研究。将患者分为2组：利妥昔单抗联合移植前PP和移植后LI（RPL）组（n = 20）和利妥昔单抗单药治疗（RM）组（n = 20）。然后比较两组患者的生存率、抗体介导的排斥反应（AMR）和感染率。结果RPL组1、3、5年生存率分别为85%、85%、85%; RM组1、3、5年生存率分别为89%、80%、80%。两组患者的生存率无显著差异。两组均未发生AMR。RM组的真菌和病毒感染率低于RPL组。结论：移植前利妥昔单抗未加其他治疗的结局与加其他治疗（如PP和LI）的结局相当。
Background Rituximab is a cornerstone in the regimens of desensitization for ABO-incompatible living-donor liver transplantation (ABO-i LDLT) that makes this modality an acceptable option for liver transplantation. Plasmapheresis (PP) to reduce anti-ABO antibody titer and local infusion (LI) therapy were practiced as the strategies for desensitization before the application of rituximab and were reported as additional treatments. The aim of this study was to clarify the feasibility of monotherapy by rituximab without any additional desensitization treatments in ABO-i LT. Methods Forty patients receiving ABO-i LDLT with rituximab were enrolled in this retrospective study. The patients were divided into 2 groups: the rituximab with pretransplant PP and posttransplant LI (RPL) group (n = 20) and the rituximab monotherapy (RM) without any additional treatment group (n = 20). The groups were then compared in terms of the rates of patient survival, antibody-mediated rejection (AMR), and infection. Results The 1-, 3-, and 5-year patient survival rates were 85%, 85%, and 85% in the RPL group and 89%, 80%, and 80% in the RM group, respectively. There was no significant difference in patient survival between the 2 groups. There were no episodes of AMR in either group. The RM group had a lower rate of fungal and viral infections than the RPL group. Conclusions Pretransplant rituximab without additional treatments yielded satisfactory outcomes comparable to that with additional treatments, such as PP and LI.