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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...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Korean Academy of Medical Sciences
2014
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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] |
format | Online Article Text |
id | pubmed-4024948 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | The Korean Academy of Medical Sciences |
record_format | MEDLINE/PubMed |
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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