Current Status of ABO-incompatible Liver Transplantation.

Abstract

By 2014, strategies to prevent antibody-mediated rejection (AMR) after ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) were established in Japan and expanded primarily to Asia, where LDLT is now the predominant form of LT owing to the scarcity of brain-dead donors. A desensitization protocol consisting of rituximab (375 mg/m 2 ), plasma pheresis, tacrolimus, and mycophenolate mofetil before LDLT, followed by standard immunosuppression, is currently the best option in terms of safety and efficacy. Rituximab administration is now known not to increase the risk of hepatocellular carcinoma recurrence, and the feasibility of rituximab for LDLT for acute liver failure and the need for desensitization before LDLT in children older than 1 y have been documented. Strategies are needed to distinguish patients at high risk of AMR from those at low risk and to adjust immunosuppression to prevent both AMR and infection. Specific single-nucleotide polymorphisms in genes encoding Fcγ receptors affecting the cytotoxicity of rituximab on B cells could be useful for adjusting immunosuppression levels to decrease infectious complications. Immunological accommodation after ABO-I transplantation could be provided by immune factors in both the grafts and recipients.

• Authors: Hiroto Egawa, Hideki Ohdan, Kazuhide Saito
• Journal: Transplantation (Transplantation) Vol. 107 Issue 2 Pg. 313-325 (02 01 2023) ISSN: 1534-6080 [Electronic] United States
• PMID: 35849558 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Rituximab
• Antibodies
• ABO Blood-Group System

Topics

• Child
• Humans
• Rituximab (therapeutic use)
• Liver Transplantation (adverse effects, methods)
• Living Donors
• Blood Group Incompatibility
• Antibodies
• Liver Neoplasms (etiology)
• ABO Blood-Group System
• Graft Rejection (prevention & control)