Clinical research of effect of Rituximab+IVIG regimen to prevent pediatric ABO incompatible living donor liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

QU Wei ^1,2 ,  ZHU Zhijun ^1,2 , WEI Lin ² , SUN Liying ² , ZENG Zhigui ² , LIU Ying ² , WANG Jun ² , TAN Yule ² , ZHANG Jinping ²

1. Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, P. R. China;
2. Clinical Center for Pediatric Liver Transplantation, National Clinical Research Center of Digestive Diseases, Capital Medical University, Beijing 100050, P. R. China;

Corresponding author：

ZHU Zhijun, Email: zhu-zhijun@outlook.com

Keywords：

ABO incompatible living donor liver transplantation; Rituximab; intravenous immunoglobulin; blood group antibody mediated rejection

DOI：

10.7507/1007-9424.202104027

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Objective To observe the clinical effect of Rituximab combined with intravenous immunoglobulin (IVIG) in preventing blood group antibody mediated rejection (AMR) in pediatric ABO incompatible living donor liver transplantation (ABOi-LDLT).Methods A total of 503 cases of pediatric living donor liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were retrospectively collected; the overall survival of recipient and graft were compared between ABOi-LDLT and ABO compatible living donor liver transplantation (ABOc-LDLT), and we summarized the data of AMR in 7 cases received Rituximab+IVIG protocol.Results There were 53 cases of ABOi-LDLT and 450 cases of ABOc-LDLT in our study. The 5-year cumulative survival rate of recipients and grafts was 98.0% and 96.0% in the ABOi-LDLT group respectively, and in ABOc-LDLT group was 92.2% and 89.1% respectively, there was no significant difference between the two groups (P=0.232, P=0.381）. Seven children with blood group antibody titer >1∶64 were included in the study. On the basis of classical intensive immunosuppressive therapy, all patients were treated with Rituximab+IVIG. The blood group antibody titer of 6 patients remained stable, and no rejection occurred; one patient developed severe AMR and graft failure, and recovered after salvage treatment of ABOc-LDLT.Conclusion Rituximab+IVIG can be used as an effective therapeutic option to prevent blood group AMR after ABOi-LDLT.

Citation： QU Wei, ZHU Zhijun, WEI Lin, SUN Liying, ZENG Zhigui, LIU Ying, WANG Jun, TAN Yule, ZHANG Jinping. Clinical research of effect of Rituximab+IVIG regimen to prevent pediatric ABO incompatible living donor liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(8): 987-991. doi: 10.7507/1007-9424.202104027 Copy

1.	孙丽莹, 朱志军, 魏林, 等. ABO血型不相容肝移植15例临床分析. 中华器官移植杂志, 2015, 36(8): 477-480.
2.	Hashimoto T, Kondo S, Suzuki T, et al. Strategy for ABO-incompatible living-related liver transplantation. Transplant Proc, 2000, 32(7): 2104-2106.
3.	Varela-Fascinetto G, Treacy SJ, Lillehei CW, et al. Long-term results in pediatric ABO-incompatible liver transplantation. Transplant Proc, 1999, 31(1-2): 467-468.
4.	Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation. Transplantation, 2004, 77(3): 403-411.
5.	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.
6.	Kim JM, Kwon CH, Joh JW, et al. ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor. J Hepatol, 2013, 59(6): 1215-1222.
7.	Ikegami T, Shirabe K, Soejima Y, et al. Feasibility of ABO-incompatible living donor liver transplantation in the rituximab era. Liver Transpl, 2010, 16(11): 1332-1333.
8.	Tanabe M, Kawachi S, Obara H, et al. Current progress in ABO-incompatible liver transplantation. Eur J Clin Invest, 2010, 40(10): 943-949.
9.	Kim JD, Choi DL, Han YS. Fourteen successful consecutive cases of ABO-incompatible living donor liver transplantation: new simplified intravenous immunoglobulin protocol without local infusion therapy. Transplant Proc, 2014, 46(3): 754-757.
10.	Yoshizawa A, Sakamoto S, Ogawa K, et al. New protocol of immunosuppression for liver transplantation across ABO barrier: the use of Rituximab, hepatic arterial infusion, and preservation of spleen. Transplant Proc, 2005, 37(4): 1718-1719.
11.	Egawa H. Challenge to ABO blood type barrier in living donor liver transplantation. Hepatobiliary Pancreat Dis Int, 2020, 19(4): 342-348.
12.	Egawa H, Umeshita K, Uemoto S. Optimal dosage regimen for rituximab in ABO-incompatible living donor liver transplantation. J Hepatobiliary Pancreat Sci, 2017, 24(2): 89-94.
13.	Tokodai K, Kumagai-Braesch M, Karadagi A, et al. Blood group antigen expression in isolated human liver cells in preparation for implementing clinical ABO-incompatible hepatocyte transplantation. J Clin Exp Hepatol, 2020, 10(2): 106-113.
14.	Haga H, Egawa H, Fujimoto Y, et al. Acute humoral rejection and C4d immunostaining in ABO blood type-incompatible liver transplantation. Liver Transpl, 2006, 12(3): 457-464.
15.	Kobayashi T. Standardization of the assay method for anti-A/B antibody titers and its problems. International Congress Series, 2006, 1292: 3-7.
16.	Egawa H, Ohmori K, Haga H, et al. B-cell surface marker analysis for improvement of rituximab prophylaxis in ABO-incompatible adult living donor liver transplantation. Liver Transpl, 2007, 13(4): 579-588.

1. 孙丽莹, 朱志军, 魏林, 等. ABO血型不相容肝移植15例临床分析. 中华器官移植杂志, 2015, 36(8): 477-480.
2. Hashimoto T, Kondo S, Suzuki T, et al. Strategy for ABO-incompatible living-related liver transplantation. Transplant Proc, 2000, 32(7): 2104-2106.
3. Varela-Fascinetto G, Treacy SJ, Lillehei CW, et al. Long-term results in pediatric ABO-incompatible liver transplantation. Transplant Proc, 1999, 31(1-2): 467-468.
4. Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation. Transplantation, 2004, 77(3): 403-411.
5. 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.
6. Kim JM, Kwon CH, Joh JW, et al. ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor. J Hepatol, 2013, 59(6): 1215-1222.
7. Ikegami T, Shirabe K, Soejima Y, et al. Feasibility of ABO-incompatible living donor liver transplantation in the rituximab era. Liver Transpl, 2010, 16(11): 1332-1333.
8. Tanabe M, Kawachi S, Obara H, et al. Current progress in ABO-incompatible liver transplantation. Eur J Clin Invest, 2010, 40(10): 943-949.
9. Kim JD, Choi DL, Han YS. Fourteen successful consecutive cases of ABO-incompatible living donor liver transplantation: new simplified intravenous immunoglobulin protocol without local infusion therapy. Transplant Proc, 2014, 46(3): 754-757.
10. Yoshizawa A, Sakamoto S, Ogawa K, et al. New protocol of immunosuppression for liver transplantation across ABO barrier: the use of Rituximab, hepatic arterial infusion, and preservation of spleen. Transplant Proc, 2005, 37(4): 1718-1719.
11. Egawa H. Challenge to ABO blood type barrier in living donor liver transplantation. Hepatobiliary Pancreat Dis Int, 2020, 19(4): 342-348.
12. Egawa H, Umeshita K, Uemoto S. Optimal dosage regimen for rituximab in ABO-incompatible living donor liver transplantation. J Hepatobiliary Pancreat Sci, 2017, 24(2): 89-94.
13. Tokodai K, Kumagai-Braesch M, Karadagi A, et al. Blood group antigen expression in isolated human liver cells in preparation for implementing clinical ABO-incompatible hepatocyte transplantation. J Clin Exp Hepatol, 2020, 10(2): 106-113.
14. Haga H, Egawa H, Fujimoto Y, et al. Acute humoral rejection and C4d immunostaining in ABO blood type-incompatible liver transplantation. Liver Transpl, 2006, 12(3): 457-464.
15. Kobayashi T. Standardization of the assay method for anti-A/B antibody titers and its problems. International Congress Series, 2006, 1292: 3-7.
16. Egawa H, Ohmori K, Haga H, et al. B-cell surface marker analysis for improvement of rituximab prophylaxis in ABO-incompatible adult living donor liver transplantation. Liver Transpl, 2007, 13(4): 579-588.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical research of effect of Rituximab+IVIG regimen to prevent pediatric ABO incompatible living donor liver transplantation

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