A simplified protocol using rituximab and immunoglobulin for ABO-incompatible low-titre living donor liver transplantation
A simplified protocol using rituximab and immunoglobulin for ABO-incompatible low-titre living donor liver transplantation
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DOI：
10.1111/liv.13614
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发表时间：
2018-05-01
影响因子：
6.7
通讯作者：
Park, Sang Jae
中科院分区：
文献类型：
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作者：
Kim, Seong Hoon;Lee, Eung Chang;Park, Sang Jae
背景与目的：关于 ABO 血型不合 (ABO-I) 活体肝移植 (LDLT) 的最佳治疗策略尚未达成共识。我们介绍了一种使用利妥昔单抗和静脉注射免疫球蛋白 (IVIG) 的简化方案。 方法：对接受 ABO-I LDLT 的成年患者进行数据分析，其中方案在 ABO 相容性 (ABO-C) LDLT 中使用的常规免疫抑制方案中，在术前添加利妥昔单抗 (300 mg/m(2))，并在术后第 1 天和第 4 天添加 IVIG (0.8 g/kg)，无需进行血浆置换、脾切除或手术。移植物局部灌注。通过1:2倾向评分匹配分析将结果与ABO-C LDLT进行比较。结果：2014年至2016年间连续识别出43例ABO-I LDLT患者。脱敏前，中位同凝素滴度为1:8（范围为1:2-1:64）。 LDLT 时滴度降至 4（范围：0-16）。没有一个显示同种凝集素滴度出现反弹上升。没有发生抗体介导的排斥反应。胆道狭窄是最常见的并发症，发生率为30.2%。选择 86 名 ABO-C LDLT 患者作为对照组。 ABO-I组和ABO-C组的急性细胞排斥、胆道并发症、感染等总体并发症发生率无统计学差异。 ABO-I 组和 ABO-C 组的 3 年累积患者生存率分别为 82.4% 和 85.9% (P = .115)。结论：使用利妥昔单抗和 IVIG 进行 ABO-I LDLT 的简化方案安全有效，可在滴度不高于 1:64 的患者中实现充分脱敏和可比较的结果。
Background & Aims: No consensus has been reached regarding optimal treatment strategies for ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). We introduce a simplified protocol using rituximab and intravenous immunoglobulin (IVIG).Methods: Data were analysed on adult patients who underwent ABO-I LDLT of which protocol added rituximab (300 mg/m(2)) before surgery and IVIG (0.8 g/kg) on post-operative days 1 and 4 to the conventional immunosuppressive regimen used in ABO-compatible (ABO-C) LDLT, without plasmapheresis, splenectomy or graft local infusion. The outcomes were compared with those of ABO-C LDLT by 1:2 propensity score-matched analysis.Results: Consecutive 43 ABO-I LDLT patients were identified between 2014 and 2016. Before desensitization, the median isoagglutinin titre was 1:8 (range, 1:2-1:64). The titre was reduced to 4 (range, 0-16) at the time of LDLT. None showed a rebound rise of isoagglutinin titres. No antibody-mediated rejection occurred. Biliary stricture was the most common complication with an incidence of 30.2%. A comparator group of 86 ABO-C LDLT patients were selected. There was no statistical difference in the overall complication rate including acute cellular rejection, biliary complications and infection between ABO-I and ABO-C groups. The 3-year cumulative patient survival rates in the ABO-I and ABO-C groups were 82.4% and 85.9% respectively (P = .115).Conclusions: A simplified protocol using rituximab and IVIG for ABO-I LDLT was safe and effective in achieving sufficient desensitization and comparable outcomes in patients with the titre no higher than 1:64.