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Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume

Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperati...

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Autores principales: Hong, Geun, Yi, Nam-Joon, Suh, Suk-won, Yoo, Tae, Kim, Hyeyoung, Park, Min-Su, Choi, YoungRok, Lee, Kyungbun, Lee, Kwang-Woong, Park, Myoung Hee, Suh, Kyung-Suk
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Academy of Medical Sciences 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024948/
https://www.ncbi.nlm.nih.gov/pubmed/24851018
http://dx.doi.org/10.3346/jkms.2014.29.5.640
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author Hong, Geun
Yi, Nam-Joon
Suh, Suk-won
Yoo, Tae
Kim, Hyeyoung
Park, Min-Su
Choi, YoungRok
Lee, Kyungbun
Lee, Kwang-Woong
Park, Myoung Hee
Suh, Kyung-Suk
author_facet Hong, Geun
Yi, Nam-Joon
Suh, Suk-won
Yoo, Tae
Kim, Hyeyoung
Park, Min-Su
Choi, YoungRok
Lee, Kyungbun
Lee, Kwang-Woong
Park, Myoung Hee
Suh, Kyung-Suk
author_sort Hong, Geun
collection PubMed
description Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe. GRAPHICAL ABSTRACT: [Image: see text]
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spelling pubmed-40249482014-05-21 Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume Hong, Geun Yi, Nam-Joon Suh, Suk-won Yoo, Tae Kim, Hyeyoung Park, Min-Su Choi, YoungRok Lee, Kyungbun Lee, Kwang-Woong Park, Myoung Hee Suh, Kyung-Suk J Korean Med Sci Original Article Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe. GRAPHICAL ABSTRACT: [Image: see text] The Korean Academy of Medical Sciences 2014-05 2014-04-25 /pmc/articles/PMC4024948/ /pubmed/24851018 http://dx.doi.org/10.3346/jkms.2014.29.5.640 Text en © 2014 The Korean Academy of Medical Sciences. http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Hong, Geun
Yi, Nam-Joon
Suh, Suk-won
Yoo, Tae
Kim, Hyeyoung
Park, Min-Su
Choi, YoungRok
Lee, Kyungbun
Lee, Kwang-Woong
Park, Myoung Hee
Suh, Kyung-Suk
Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume
title Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume
title_full Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume
title_fullStr Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume
title_full_unstemmed Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume
title_short Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer, Model for End-Stage Liver Disease Score, and Graft Liver Volume
title_sort preoperative selective desensitization of live donor liver transplant recipients considering the degree of t lymphocyte cross-match titer, model for end-stage liver disease score, and graft liver volume
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024948/
https://www.ncbi.nlm.nih.gov/pubmed/24851018
http://dx.doi.org/10.3346/jkms.2014.29.5.640
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