Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation-The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation.
Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation-The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation.
复制标题
DOI：
10.1097/txd.0000000000000760
复制
发表时间：
2018-03
影响因子：
2.3
通讯作者：
Kuroda T
中科院分区：
文献类型：
--
作者：
Yamada Y;Hoshino K;Fuchimoto Y;Matsubara K;Hibi T;Yagi H;Abe Y;Shinoda M;Kitago M;Obara H;Yagi T;Okajima H;Kaido T;Uemoto S;Suzuki T;Kubota K;Yoshizumi T;Maehara Y;Inomata Y;Kitagawa Y;Egawa H;Kuroda T
多项研究未能揭示预防肝移植（LTx）后原发性硬化性胆管炎（PSC）复发的有效方法。在日本进行的一项全国性研究揭示了活体供者LTx（LDLTx）后复发的几个风险因素;然而，ABO血型不相容（ABO-I）LTx受体被排除在先前的分析之外。在本研究中，我们研究了免疫抑制方案在ABO-I LTx中对LDLTx后PSC复发的疗效。我们进行了一项全国性调查，分析了1994年至2010年9个中心接受ABO-I LDLTx治疗PSC（n = 12）的受者的结局，并将其结局与ABO相容LDLTx治疗PSC（n = 96）的结局进行了比较。ABO-I LTx免疫抑制方案的关键要素是血浆置换以清除现有抗体，以及使用免疫抑制剂控制体液免疫。从2006年起，利妥昔单抗被添加到免疫抑制方案中; 5例患者在围手术期接受利妥昔单抗治疗。2006年之前接受ABO-I LDLTx的所有7名受体（未接受利妥昔单抗）均死于感染（n = 3）、抗体介导的排斥反应（n = 1）、ABO血型不合相关的胆管病（n = 1）或PSC复发（n = 2）。与此相反，我们发现2006年的所有5名接受者（接受利妥昔单抗治疗）保持了良好的移植功能超过7年，没有任何PSC复发。本研究的结果揭示了一种新的策略，以防止PSC复发的疗效和利妥昔单抗治疗提供的可能机制进行了讨论。
Multiple studies have failed to reveal an effective method for preventing the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LTx). A national study conducted in Japan revealed several risk factors for the recurrence after living donor LTx (LDLTx); however, recipients of ABO-blood type incompatible (ABO-I) LTx were excluded from the previous analysis. In the present study, we investigated the efficacy of an immunosuppressive protocol in ABO-I LTx on the recurrence of PSC after LDLTx. We conducted a national survey and analyzed the outcome of recipients who underwent ABO-I LDLTx for PSC (n = 12) between 1994 and 2010 in 9 centers and compared the outcome with that of ABO-compatible LDLTx for PSC (n = 96). The key elements of the immunosuppressive regimen in ABO-I LTx are plasma exchange sessions to remove existing antibodies, and the use of immunosuppression to control humoral immunity. Rituximab was added to the immunosuppression regimen from 2006 onward; 5 patients received rituximab perioperatively. All 7 recipients who underwent ABO-I LDLTx before 2006 (who did not receive rituximab) died of infection (n = 3), antibody-mediated rejection (n = 1), ABO-incompatibility associated cholangiopathy (n = 1) or recurrence of PSC (n = 2). In contrast, we found that all 5 recipients from 2006 (who were treated with rituximab) retained an excellent graft function for more than 7 years without any recurrence of PSC. The findings of this study shed light on the efficacy of a novel strategy to prevent the recurrence of PSC and the possible mechanisms provided by rituximab treatment are discussed.