Splenectomy Does Not Offer Immunological Benefits in ABO-Incompatible Liver Transplantation With a Preoperative Rituximab
Splenectomy Does Not Offer Immunological Benefits in ABO-Incompatible Liver Transplantation With a Preoperative Rituximab
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DOI：
10.1097/tp.0b013e318239e8e4
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发表时间：
2012-01-15
期刊：
影响因子：
6.2
通讯作者：
Uemoto, Shinji
中科院分区：
文献类型：
--
作者：
Raut, Vikram;Mori, Akira;Uemoto, Shinji
背景预形成的抗ABO抗体是ABO血型不合（ABO-I）肝移植（LT）后抗体介导的排斥反应（AMR）的主要原因，导致致死性肝坏死和胆道并发症。脾切除术是ABO-I LT方案的组成部分，可降低抗ABO抗体。在术前利妥昔单抗预防的情况下，脾切除术在ABO-I LT中的作用目前仍有争议。我们通过回顾性分析近期抗ABO抗体反应和ABO-I LT的长期结果来研究脾切除术的必要性。回顾性分析了2006年5月至2009年7月在日本京都京都大学医院进行的37例ABO-I LT。27例接受脾切除术的患者（脾切除术组）在活体供者LT前17.7 +/- 11.9天接受329.6 +/- 35.8 mg利妥昔单抗。10例未接受脾切除术的患者（非脾切除术组）在移植前26.6 +/- 21.3天接受320.0 +/- 10.3 mg利妥昔单抗。所有患者均接受了移植后肝动脉灌注前列腺素E1和甲基强的松龙。比较围手术期抗ABO免疫球蛋白M和免疫球蛋白G抗体滴度、排斥反应、胆道并发症、感染和生存结果。术前利妥昔单抗与血浆置换有效地降低了抗ABO抗体在两个患者组的时间LT。有没有观察到抗ABO免疫球蛋白M和免疫球蛋白G抗体滴度之间的“脾切除术”和”nonsplenectomy”组在最初的8周内没有统计学上的显着差异。两组的临床结局，包括AMR、胆道并发症、感染和生存率相似。术前利妥昔单抗有效地降低了抗ABO抗体，足以防止AMR，无论脾切除术。术前利妥昔单抗治疗的ABO-I LT中，脾切除术未提供任何免疫学获益。
Background. Preformed anti-ABO antibodies are primarily responsible for antibody-mediated rejection (AMR) after ABO-incompatible (ABO-I) liver transplantation (LT) resulting in lethal hepatic necrosis and biliary complications. Splenectomy, an integral part of protocol for ABO-I LT, decreases anti-ABO antibodies. With the preoperative rituximab prophylaxis, role of the splenectomy for ABO-I LT is now under debate. We investigated the necessity of splenectomy by retrospective analyses of the short-term anti-ABO antibody response and long-term outcomes of ABO-I LT.Methods. Thirty-seven ABO-I LTs performed from May 2006 through July 2009, at Kyoto University Hospital, Kyoto, Japan, were retrospectively analyzed. Twenty-seven patients who underwent splenectomy (splenectomy group) received 329.6 +/- 35.8 mg rituximab 17.7 +/- 11.9 days before living donor LT. Ten patients without splenectomy (nonsplenectomy group) received 320.0 +/- 10.3 mg rituximab 26.6 +/- 21.3 days before transplantation. All patients received a posttransplant hepatic artery infusion with prostaglandin E1 and methylprednisolone. Perioperative anti-ABO immunoglobulin M and immunoglobulin G antibody titers, rejections, biliary complications, infections, and survival results were compared.Results. Preoperative rituximab with plasma exchange effectively reduced anti-ABO antibodies in both patient groups at the time of LT. There was no statistically significant difference observed in anti-ABO immunoglobulin M and immunoglobulin Gantibody titers between the "splenectomy" and" nonsplenectomy" groups during the initial 8 weeks. The clinical outcomes, including AMR, biliary complications, infections, and survival, were similar in both the groups.Conclusions. Preoperative rituximab effectively decreased the anti-ABO antibodies sufficiently to prevent the AMR irrespective of splenectomy. Splenectomy does not offer any immunological benefit in ABO-I LT with preoperative rituximab.