Introduction:

ABO incompatible (ABOi) living donor liver transplantation (LDLT) is a feasible alternative for donor liver allograft in emergency situations. The reported outcomes of ABOi-LDLT after optimal desensitization are comparable to ABO-compatible LDLT. We aim to present improved outcome after ABO-i LDLT with low-dose Rituximab,double filtration plasmapheresis (DFPP) and prophylactic antibiotic therapy.

Materials and Methods:

Since January 2006 to October 2016, 35 ABOi adult LDLT were performed at China Medical University Hospital, Taiwan. We sub grouped these patients into three periods according to different desensitization protocol.

Era I (n=9) – Rituximab 375mg/m² per body surface area & DFPP if needed

Era II (n=6) – Rituximab 200mg (irrespective of patient's body surface area) and DFPP in all the patients.

Era III (n=20) – Rituximab 200mg and DFPP in all the patients with prophylactic antibiotics.

Results:

In the Era I, only two patients received DFPP. One patient suffered from hepatic artery occlusion and then developed ischemic cholangitis. Another one patient required re-transplantation due to graft failure in 2nd post-transplant month. None of the patients developed acute rejection during hospitalization.

In the Era II subgroup, ABOi LDLT was performed in six patients. However, five patients (83%) developed infection during hospitalization or within 3 months after LT. In these five patients, one patient developed ischemic cholangitis due to hepatic artery occlusion. One patient suffered from spine osteomyelitis whereas 3 patients (50%) expired due to overwhelming sepsis.

In the Era III, ABOi LDLT was performed in 20 patients and all the patients received prophylactic antibiotics (Sulfamethoxazole 400mg/Trimethoprim 80mg) for 3 months after LDLT.The extracorporeal membrane oxygenation (ECMO) support was required in 2 of the patients in post-transplant period with complete recovery. Two patients in this subgroup expired due to hepatocellular carcinoma metastasis. Acute cellular rejection was diagnosed in 2 patients.

Conclusions:

Lowering the dose of rituximab with prophylactic antibiotics in ABOi-LDLT patients can improve the survival significantly. Our successful experience shows the ABOi-LDLT can be performed in patients with pre-transplant infection with addition of prophylactic antibiotics.

CITATION INFORMATION: Hsu S.-C, Thorat A, Jeng L.-B, Yang H.-R, Li P.-C, Yeh C.-C, Chen T.-H, Poon K.-S. Reduced Rituximab with Prophylactic Antibiotic Treatment Improves the Infectious Complications in Patients Undergoing ABO-Incompatible Living Donor Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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