Background: Adult living donor liver transplantation can be performed across ABO blood type barrier successfully by depleting B cells using rituximab. However, the patients with high isoagglutinin titers may have rebound of isoagglutinin to induce acute antibody-mediated rejection after transplantation. This study is to present a new desensitization regimen foradult ABO-incompatible living donor liver transplantation recipients with high isoagglutinin titers.

Materials and methods: The adult patients who received ABO-incompatible living donor liver transplantation with high isoagglutinin titers were included in this study. A high isoagglutinin titer was defined as ≥ 256. The patients received rituximab (375mg/m²) to deplete B cells 3 weeks before transplantation. A week before transplantation, bortezomib (3.5mg) was given to deplete plasma cells, followed by plasma exchanged to achieve isoagglutinin titer ≤ 64. The titers of isoagglutinin were all ≤ 64 for every recipients' before transplantation.

Results:Eighteen patients, 14 males and 4 females, were included in this study. The median (interquartile) of MELD was 15.5 (8-18.5). The median (interquartile) of isoagglutinin titer was 512 (256-1024) initially. The courses of plasma exchange was 4.1±2.5. All the patients'isoagglutinin reached ≤ 64 immediately before transplantation. After transplantation, 3 patients (16.7%) had elevated isoagglutinin ≥128. Nine patients (50%) had biliary complications, including 8 biliary stenosis at anastomotic sites and one ischemic biliary stricture. For all these patients, one-year survival was 83.3% and three-year survival was 64.1%.

Conclusion: Adult ABO-incompatible living donor liver transplantation with a high titer of isoagglutinin may have a higher risk of antibody-mediated rejection. Under this new desensitization regimen to deplete B cells and plasma cells, the incidence of isoagglutinin rebound was low. Adult ABO-incompatible living donor liver transplantation can be performed successfully.

CITATION INFORMATION: Lee W.-C, Lee C.-F, Wu T.-H, Wang Y.-C, Cheng C.-H, Wu T.-J, Chou H.-S, Chan K.-M. Desensitization Regimen for the Patients with High Isoagglutinin Titers to Undergo Adult ABO-Incompatible Living Donor Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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