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ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report

INTRODUCTION AND IMPORTANCE: ABO-incompatible living donor liver transplantation (ABOi-LDLT) is essential for expanding the donor pool. ABOi-LDLT prognosis has improved since desensitization treatment with rituximab; however, patients with high antibody titers are considered to be at high risk of an...

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Autores principales: Saitoh, Yoshikatsu, Fujio, Atsushi, Miyagi, Shigehito, Tokodai, Kazuaki, Unno, Michiaki, Kamei, Takashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350003/
https://www.ncbi.nlm.nih.gov/pubmed/34343790
http://dx.doi.org/10.1016/j.ijscr.2021.106260
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author Saitoh, Yoshikatsu
Fujio, Atsushi
Miyagi, Shigehito
Tokodai, Kazuaki
Unno, Michiaki
Kamei, Takashi
author_facet Saitoh, Yoshikatsu
Fujio, Atsushi
Miyagi, Shigehito
Tokodai, Kazuaki
Unno, Michiaki
Kamei, Takashi
author_sort Saitoh, Yoshikatsu
collection PubMed
description INTRODUCTION AND IMPORTANCE: ABO-incompatible living donor liver transplantation (ABOi-LDLT) is essential for expanding the donor pool. ABOi-LDLT prognosis has improved since desensitization treatment with rituximab; however, patients with high antibody titers are considered to be at high risk of antibody mediated rejection (AMR). Nevertheless, the preoperative antibody titer cutoff levels that preclude ABOi-LDLT have not yet been determined. In this study, the highest preoperative antibody titer was 1:4096, and the recipient had good outcomes. There has been only one report of good outcomes with a preoperative antibody titer of more than 1:4096. We hypothesized that high preoperative antibody titers in ABOi-LDLT may not be associated with AMR in protocols involving rituximab. CASE PRESENTATION: The recipient was a 22-year-old man with biliary atresia and underwent ABOi-LDLT (B to O). We administered 500 mg of rituximab 14 days prior and then 300 mg of rituximab one day prior to ABOi-LDLT. The recipients preoperative IgG antibody titer was 1:4096. Postoperative immunosuppressive protocol involved steroids, tacrolimus, and mycophenolate mofetil. The patient had satisfactory graft function three years following ABOi-LDLT. CLINICAL DISCUSSION: The antibody that is responsible for posttransplant AMR should be newly synthesized after transplantation as a result of sensitization by antigens on the vascular endothelial cells of the graft. In ABOi-LDLT, natural antibodies may not cause AMR. CONCLUSIONS: The most important factor for preventing AMR in recipients undergoing ABOi-LDLT is the suppression of de novo antibodies. High preoperative antibody titers may not necessarily preclude ABOi-LDLT, provided that rituximab is used in desensitization.
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spelling pubmed-83500032021-08-15 ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report Saitoh, Yoshikatsu Fujio, Atsushi Miyagi, Shigehito Tokodai, Kazuaki Unno, Michiaki Kamei, Takashi Int J Surg Case Rep Case Report INTRODUCTION AND IMPORTANCE: ABO-incompatible living donor liver transplantation (ABOi-LDLT) is essential for expanding the donor pool. ABOi-LDLT prognosis has improved since desensitization treatment with rituximab; however, patients with high antibody titers are considered to be at high risk of antibody mediated rejection (AMR). Nevertheless, the preoperative antibody titer cutoff levels that preclude ABOi-LDLT have not yet been determined. In this study, the highest preoperative antibody titer was 1:4096, and the recipient had good outcomes. There has been only one report of good outcomes with a preoperative antibody titer of more than 1:4096. We hypothesized that high preoperative antibody titers in ABOi-LDLT may not be associated with AMR in protocols involving rituximab. CASE PRESENTATION: The recipient was a 22-year-old man with biliary atresia and underwent ABOi-LDLT (B to O). We administered 500 mg of rituximab 14 days prior and then 300 mg of rituximab one day prior to ABOi-LDLT. The recipients preoperative IgG antibody titer was 1:4096. Postoperative immunosuppressive protocol involved steroids, tacrolimus, and mycophenolate mofetil. The patient had satisfactory graft function three years following ABOi-LDLT. CLINICAL DISCUSSION: The antibody that is responsible for posttransplant AMR should be newly synthesized after transplantation as a result of sensitization by antigens on the vascular endothelial cells of the graft. In ABOi-LDLT, natural antibodies may not cause AMR. CONCLUSIONS: The most important factor for preventing AMR in recipients undergoing ABOi-LDLT is the suppression of de novo antibodies. High preoperative antibody titers may not necessarily preclude ABOi-LDLT, provided that rituximab is used in desensitization. Elsevier 2021-07-31 /pmc/articles/PMC8350003/ /pubmed/34343790 http://dx.doi.org/10.1016/j.ijscr.2021.106260 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Saitoh, Yoshikatsu
Fujio, Atsushi
Miyagi, Shigehito
Tokodai, Kazuaki
Unno, Michiaki
Kamei, Takashi
ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report
title ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report
title_full ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report
title_fullStr ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report
title_full_unstemmed ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report
title_short ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report
title_sort abo-incompatible living donor liver transplantation with high preoperative antibody titer: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8350003/
https://www.ncbi.nlm.nih.gov/pubmed/34343790
http://dx.doi.org/10.1016/j.ijscr.2021.106260
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