Introduction The negative impact of preformed anti-HLA donor specific antibodies (DSAs) in liver transplantation is clearly established. However, the potential interest of a B-cell depleting agent for induction is unknown. The aim was this retrospective study was to assess the effect of rituximab induction therapy in liver-transplant patients with preformed DSAs.

Patients & method: Between 2004 to 2016, all liver recipients transplanted in participating centers were screened for DSAs at day 0, and after transplantation (Luminex SA assay, cut-off MFI >1000). All rejection episodes were biopsy proven and graded according to the 2016 Banff classification. All clinical events (hospitalization for infectious complication, cancer, and death) were reported.

Results: 51 of the 728 liver-transplants performed during the study period had preformed DSAs [18 anti-class I, 7 anti-class- II and 16 anti-class I and II]. In 15 cases, the crossmatch was positive (XM+). Rituximab was given as induction therapy in 17 patients (7 with XM+), associated with polyclonal antibodies (n=15) or anti-IL2R (n=2). In the remaining patients, 13 were given induction therapy by polyclonal antibodies or 11 patients were given anti-IL2R. The last 10 patients did not received an induction therapy. 18 patients developed at least one episode of acute rejection (5/17 in the rituximab group and 13/34 in the group without rituximab, p=ns). Four patients met the criteria for acute antibody mediated rejection. Of these, one had received rituximab induction therapy. The grafts' survivals at 1, 3 and 5 years were 82%, 67% et 50% in the rituximab group and 91%, 80% et 57% in the group who did not receive rituximab (p=ns). Metavir scores and cAMR scores were similar in liver biopsies performed at one-year post transplantation in both groups. The 5 years post-transplant infectious complication rate was similar in patient who received or not rituximab induction therapy (35% vs. 24%, p=ns).

Conclusions: In this retrospective multicenter study, the use of rituximab induction therapy did not significantly modify the outcome of liver-transplant patients with preformed DSAs.

CITATION INFORMATION: Del Bello A, Dubois V, Dumortier J, Congy-Jolivet N, Kamar N. Impact of a B-Cell Targeting Agent on Antibody Mediated Rejection and Graft' Survival in Liver Transplantation with Preformed DSAs. Am J Transplant. 2017;17 (suppl 3).

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