Impact of Rituximab Desensitization on Blood-Type-Incompatible Adult Living Dono

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http://onlinelibrary.wiley.com/doi/10.1111/ajt.12520/abstract

Impact of Rituximab Desensitization on Blood-Type-Incompatible Adult Living Donor Liver Transplantation: A Japanese Multicenter Study
H. Egawa1,*, S. Teramukai2, H. Haga3, M. Tanabe4, A. Mori5, T. Ikegami6, N. Kawagishi7, H. Ohdan8, M. Kasahara9, K. Umes***a10
DOI: 10.1111/ajt.12520
American Journal of Transplantation
Early View (Online Version of Record published before inclusion in an issue)

Abstract
We evaluated the effects of rituximab prophylaxis on outcomes of ABO-blood-type-incompatible living donor liver transplantation (ABO-I LDLT) in 381 adult patients in the Japanese registry of ABO-I LDLT. Patients underwent dual or triple immunosuppression with or without B cell desensitization therapies such as plasmapheresis, splenectomy, local infusion, intravenous immunoglobulin and rituximab. Era before 2005, intensive care unit-bound status, high Model for End-Stage Liver Disease score and absence of rituximab prophylaxis were significant risk factors for overall survival and antibody-mediated rejection (AMR) in the univariate analysis. After adjustment for era effects in the multivariate analysis, only absence of rituximab prophylaxis was a significant risk factor for AMR, and there were no significant risk factors for survival. Rituximab prophylaxis significantly decreased the incidence of AMR, especially hepatic necrosis (p < 0.001). In the rituximab group, other B cell desensitization therapies had no add-on effects. Multiple or large rituximab doses significantly increased the incidence of infection, and early administration had no advantage. In conclusion, outcomes in adult ABO-I LDLT have significantly improved in the latest era coincident with the introduction of rituximab.