Background: Plasmapheresis is a desensitization method used prior to ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). However, studies on its usefulness in the rituximab era are lacking.

Methods: Fifty-six adult patients underwent ABO-I LDLT between January 2012 and October 2015. A single dose of rituximab (300 mg/m²) was administered 2 weeks before ABO-I LDLT; this was administered with plasmapheresis in all patients until February 2014 (RP group, n=26). Patients were administered rituximab only, with no plasmapheresis from March 2014 onward (RO group, n=30).

Results: The 6-, 12-, and 18-month overall survival rates were 92.3 %, 80.8%, and 76.9% in the RP group and 96.6 %, 85.4 %, and 85.4 % in the RO group, respectively (P = 0.574). Neither group contained patients with initial isoagglutinin titers < 16 who then showed a rebound rise of isoagglutinin titers after ABO-I LDLT. For patients with initial isoagglutinin titers ≥ 16, the rebound rise of isoagglutinin titers was more prominent in the RP group, and this difference was observed continuously from 1 week (P = 0.019) to 20 weeks (P = 0.021) after ABO-I LDLT. When the two groups were compared in a stratified analysis by the initial isoagglutinin titers, there was no difference in time-dependent changes in B cell subpopulations, or in ABO-I-related complications.

Conclusion: Sufficient desensitization for ABO-I LDLT can be achieved using rituximab alone. This does not affect patient survival, and is not accompanied by an increase in rebound rise of isoagglutinin titers or ABO-I-related complications.

CITATION INFORMATION: Lee E, Kim S, Lee S, Park S.-J. A Comparison of Desensitization Protocols: Rituximab with/without Plasmapheresis in ABO-Incompatible Living Donor Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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