Randomized controlled trial of the application of basiliximab in ABO incompatible pediatric liver transplantation: preliminary results_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SUN Chao , DONG Chong , ZHENG Weiping , WANG Kai , QIN Hong , YANG Yang , HAN Chao , ZHANG Fubo , SONG Zhuolun , CAO Shunqi , XU Min ,  GAO Wei

Department of Pediatric Transplantation, Tianjin First Central Hospital/Tianjin Key Laboratory for Organ Transplantation, Tianjin 300192, P. R. China;

Corresponding author：

GAO Wei, Email: gaowei_tjfch@163.com

Keywords：

liver transplantation; child; ABO incompatible; basiliximab; rejection

DOI：

10.7507/1007-9424.202103064

Video：

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Objective To compare the effect and safety of basiliximab in ABO incompatible pediatric liver transplant recipients.Methods ABO incompatible pediatric liver transplantation operated between January 2019 and August 2020 were studied. The patients were allocated randomized into two groups. Patients in experimental group were treated with basiliximab as immune induction therapy, but basiliximab was not used in patients of control group. Tacrolimus combined methylprednisolone were used after liver transplantation. The clinical characteristics, graft and recipient survival rate, rejection, infectious complications, and kidney functions after liver transplantation were observed. Donor specific antibody (DSA) was tested in 3 months after liver transplantation. The growth and development were assessed too after liver transplant.Results Fourty-four patients were enrolled in the study, including 19 patients in the experimental group and 25 patients in the control group. The median follow-up time was 16.6 months (3.8–25.4 months), and there were no statistically differences between the two groups in terms of age, sex, weight, pediatric end-stage liver disease (PELD) score, and other basic conditions. There were no significant differences between the two groups in tacrolimus dose, tacrolimus trough concentration, kidney functions, height and weight growth after liver transplantation. There were no statistical differences in lung infection, blood stream infection within 3 months after liver transplantation, cytomegalovirus, EBV infection, graft/patient survival rate after liver transplantation (P>0.05). However, the acute rejection rate was lower and the DSA positive rate in 3 months after liver transplantation was lower in the experimental group (P<0.05).Conclusions Basiliximab can be safely used in ABO incompatible pediatric liver transplant recipients. Acute rejection rate and DSA positive rate after transplantation can be decreased with the useof basiliximab.

Citation： SUN Chao, DONG Chong, ZHENG Weiping, WANG Kai, QIN Hong, YANG Yang, HAN Chao, ZHANG Fubo, SONG Zhuolun, CAO Shunqi, XU Min, GAO Wei. Randomized controlled trial of the application of basiliximab in ABO incompatible pediatric liver transplantation: preliminary results. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(8): 997-1002. doi: 10.7507/1007-9424.202103064 Copy

1.	Honda M, Sugawara Y, Kadohisa M, et al. Long-term outcomes of ABO-incompatible pediatric living donor liver transplantation. Transplantation, 2018, 102(10): 1702-1709.
2.	Crins ND, Röver C, Goralczyk AD, et al. Interleukin-2 receptor antagonists for pediatric liver transplant recipients: A systematic review and meta-analysis of controlled studies. Pediatr Transplant, 2014, 18(8): 839-850.
3.	Ganschow R, Grabhorn E, Schulz A, et al. Long-term results of basiliximab induction immunosuppression in pediatric liver transplant recipients. Pediatr Transplant, 2005, 9(6): 741-745.
4.	Newland DM, Royston MJ, McDonald DR, et al. Analysis of rabbit anti-thymocyte globulin vs basiliximab induction in pediatric liver transplant recipients. Pediatr Transplant, 2019, 23(8): e13573.
5.	Sun C, Song Z, Ma N, et al. The management and outcomes of ABO-incompatible pediatric liver transplantation: Experience of a single Chinese center. J Pediatr Surg, 2020, 55(12): 2647-2652.
6.	高卓, 王旖旎. EB病毒DNA检测应尽早实现标准化. 中华传染病杂志, 2017, 35(5): 318-320.
7.	Lee B, Choi Y, Han HS, et al. ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer. Ann Hepatobiliary Pancreat Surg, 2019, 23(3): 211-218.
8.	Bajpai M, Kakkar B, Gupta S, et al. Cascade plasmapheresis as a desensitization strategy for patients undergoing ABO incompatible living donor liver transplantation (ABOi LDLT): A single center experience. Transfus Apher Sci, 2019, 58(4): 442-446.
9.	Mysore KR, Himes RW, Rana A, et al. ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes. Pediatr Transplant, 2018, 22(7): e13263.
10.	Ueda D, Yoshizawa A, Kaneshiro M, et al. Low titers of antidonor ABO antibodies after ABO-incompatible living donor liver transplantation: A long-term follow-up study. Transplant Direct, 2018, 5(1): e420.
11.	Kim SH, Park J, Park SJ. Impact of ABO-incompatibility on hepatic artery thrombosis in living donor liver transplantation. Ann Transl Med, 2019, 7(22): 625.
12.	Oh J, Kim JM. Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation. Clin Mol Hepatol, 2020, 26(1): 1-6.
13.	Egawa H. Challenge to ABO blood type barrier in living donor liver transplantation. Hepatobiliary Pancreat Dis Int, 2020, 19(4): 342-348.
14.	Di Filippo S. Anti-IL-2 receptor antibody vs. polyclonal anti-lymphocyte antibody as induction therapy in pediatric transplantation. Pediatr Transplant, 2005, 9(3): 373-380.
15.	Turner AP, Knechtle SJ. Induction immunosuppression in liver transplantation: a review. Transpl Int, 2013, 26(7): 673-683.
16.	Ganschow R, Broering DC, Stuerenburg I, et al. First experience with basiliximab in pediatric liver graft recipients. Pediatr Transplant, 2001, 5(5): 353-358.
17.	陈凡, 高伟, 孙超, 等. 巴利昔单抗对儿童肝移植受者的有效性及安全性评价. 中华小儿外科杂志, 2017, 38(1): 42-45.
18.	Mouzaki M, Yap J, Avinashi V, et al. Basiliximab with delayed introduction of calcineurin inhibitors as a renal-sparing protocol following liver transplantation in children with renal impairment. Pediatr Transplant, 2013, 17(8): 751-756.
19.	Spada M, Petz W, Bertani A, et al. Randomized trial of basiliximab induction versus steroid therapy in pediatric liver allograft recipients under tacrolimus immunosuppression. Am J Transplant, 2006, 6(8): 1913-1921.
20.	Tokodai K, Miyagi S, Nakanishi C, et al. Association of post-transplant donor-specific HLA antibody with liver graft fibrosis during long-term follow-up after pediatric liver transplantation. Pediatr Transplant, 2018, 22(3): e13169.
21.	孙超, 孟醒初, 董冲, 等. 小儿血型不合活体肝移植的临床疗效分析. 器官移植, 2020, 11(4): 466-470.

1. Honda M, Sugawara Y, Kadohisa M, et al. Long-term outcomes of ABO-incompatible pediatric living donor liver transplantation. Transplantation, 2018, 102(10): 1702-1709.
2. Crins ND, Röver C, Goralczyk AD, et al. Interleukin-2 receptor antagonists for pediatric liver transplant recipients: A systematic review and meta-analysis of controlled studies. Pediatr Transplant, 2014, 18(8): 839-850.
3. Ganschow R, Grabhorn E, Schulz A, et al. Long-term results of basiliximab induction immunosuppression in pediatric liver transplant recipients. Pediatr Transplant, 2005, 9(6): 741-745.
4. Newland DM, Royston MJ, McDonald DR, et al. Analysis of rabbit anti-thymocyte globulin vs basiliximab induction in pediatric liver transplant recipients. Pediatr Transplant, 2019, 23(8): e13573.
5. Sun C, Song Z, Ma N, et al. The management and outcomes of ABO-incompatible pediatric liver transplantation: Experience of a single Chinese center. J Pediatr Surg, 2020, 55(12): 2647-2652.
6. 高卓, 王旖旎. EB病毒DNA检测应尽早实现标准化. 中华传染病杂志, 2017, 35(5): 318-320.
7. Lee B, Choi Y, Han HS, et al. ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer. Ann Hepatobiliary Pancreat Surg, 2019, 23(3): 211-218.
8. Bajpai M, Kakkar B, Gupta S, et al. Cascade plasmapheresis as a desensitization strategy for patients undergoing ABO incompatible living donor liver transplantation (ABOi LDLT): A single center experience. Transfus Apher Sci, 2019, 58(4): 442-446.
9. Mysore KR, Himes RW, Rana A, et al. ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes. Pediatr Transplant, 2018, 22(7): e13263.
10. Ueda D, Yoshizawa A, Kaneshiro M, et al. Low titers of antidonor ABO antibodies after ABO-incompatible living donor liver transplantation: A long-term follow-up study. Transplant Direct, 2018, 5(1): e420.
11. Kim SH, Park J, Park SJ. Impact of ABO-incompatibility on hepatic artery thrombosis in living donor liver transplantation. Ann Transl Med, 2019, 7(22): 625.
12. Oh J, Kim JM. Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation. Clin Mol Hepatol, 2020, 26(1): 1-6.
13. Egawa H. Challenge to ABO blood type barrier in living donor liver transplantation. Hepatobiliary Pancreat Dis Int, 2020, 19(4): 342-348.
14. Di Filippo S. Anti-IL-2 receptor antibody vs. polyclonal anti-lymphocyte antibody as induction therapy in pediatric transplantation. Pediatr Transplant, 2005, 9(3): 373-380.
15. Turner AP, Knechtle SJ. Induction immunosuppression in liver transplantation: a review. Transpl Int, 2013, 26(7): 673-683.
16. Ganschow R, Broering DC, Stuerenburg I, et al. First experience with basiliximab in pediatric liver graft recipients. Pediatr Transplant, 2001, 5(5): 353-358.
17. 陈凡, 高伟, 孙超, 等. 巴利昔单抗对儿童肝移植受者的有效性及安全性评价. 中华小儿外科杂志, 2017, 38(1): 42-45.
18. Mouzaki M, Yap J, Avinashi V, et al. Basiliximab with delayed introduction of calcineurin inhibitors as a renal-sparing protocol following liver transplantation in children with renal impairment. Pediatr Transplant, 2013, 17(8): 751-756.
19. Spada M, Petz W, Bertani A, et al. Randomized trial of basiliximab induction versus steroid therapy in pediatric liver allograft recipients under tacrolimus immunosuppression. Am J Transplant, 2006, 6(8): 1913-1921.
20. Tokodai K, Miyagi S, Nakanishi C, et al. Association of post-transplant donor-specific HLA antibody with liver graft fibrosis during long-term follow-up after pediatric liver transplantation. Pediatr Transplant, 2018, 22(3): e13169.
21. 孙超, 孟醒初, 董冲, 等. 小儿血型不合活体肝移植的临床疗效分析. 器官移植, 2020, 11(4): 466-470.

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Randomized controlled trial of the application of basiliximab in ABO incompatible pediatric liver transplantation: preliminary results

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