Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation-The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation

Transplantation Direct
Yohei YamadaTatsuo Kuroda

Abstract

Multiple studies have failed to reveal an effective method for preventing the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LTx). A national study conducted in Japan revealed several risk factors for the recurrence after living donor LTx (LDLTx); however, recipients of ABO-blood type incompatible (ABO-I) LTx were excluded from the previous analysis. In the present study, we investigated the efficacy of an immunosuppressive protocol in ABO-I LTx on the recurrence of PSC after LDLTx. We conducted a national survey and analyzed the outcome of recipients who underwent ABO-I LDLTx for PSC (n = 12) between 1994 and 2010 in 9 centers and compared the outcome with that of ABO-compatible LDLTx for PSC (n = 96). The key elements of the immunosuppressive regimen in ABO-I LTx are plasma exchange sessions to remove existing antibodies, and the use of immunosuppression to control humoral immunity. Rituximab was added to the immunosuppression regimen from 2006 onward; 5 patients received rituximab perioperatively. All 7 recipients who underwent ABO-I LDLTx before 2006 (who did not receive rituximab) died of infection (n = 3), antibody-mediated rejection (n = 1), ABO-incompatibility associated cholangiopathy (...Continue Reading

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Citations

Feb 2, 2019·World Journal of Hepatology·Trevor J LabordaMark Deneau
Jul 21, 2020·World Journal of Gastroenterology : WJG·Charis D ManganisEmma L Culver
Jun 4, 2020·Annals of Gastroenterological Surgery·Masahiro OhiraHideki Ohdan
Feb 26, 2021·Transplant International : Official Journal of the European Society for Organ Transplantation·Nobuhisa AkamatsuHajime Takikawa
Jun 29, 2021·Seminars in Liver Disease·Kristel K LeungAliya Gulamhusein

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Methods Mentioned

BETA
biopsies

Software Mentioned

GraphPad Prism
SPSS

Related Concepts

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