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.
10.3346/jkms.2014.29.5.640
- Author:
Geun HONG
1
;
Nam Joon YI
;
Suk Won SUH
;
Tae YOO
;
Hyeyoung KIM
;
Min Su PARK
;
Youngrok CHOI
;
Kyungbun LEE
;
Kwang Woong LEE
;
Myoung Hee PARK
;
Kyung Suk SUH
Author Information
1. Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. gsleenj@hanmail.net
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Blood Grouping and Crossmatching;
Desensitization;
Graft Rejection;
Living Donors;
Liver Transplantation
- MeSH:
ABO Blood-Group System/immunology;
Adult;
Antibodies, Monoclonal, Murine-Derived/therapeutic use;
Desensitization, Immunologic/*methods;
End Stage Liver Disease/surgery;
Female;
Graft Rejection/immunology;
Graft Survival/*immunology;
Histocompatibility Testing;
Humans;
Liver/surgery;
*Liver Transplantation;
Living Donors;
Male;
Middle Aged;
Plasmapheresis;
Preoperative Care;
Retrospective Studies;
Severity of Illness Index;
Survival Rate;
T-Lymphocytes/*immunology;
*Transplant Recipients
- From:Journal of Korean Medical Science
2014;29(5):640-647
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
