Purpose: Since a variety of desensitization strategies including rituximab, intravenous immunoglobulin (IVIG), and plasma exchange (PE) have been introduced, the survival and outcomes of recipients of ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) have markedly improved. We introduce amodified protocol using rituximab and intravenous immunoglobulin (IVIG) without plasma exchange (PE).

Methods: Data were retrospectively analyzed on adult patients who underwent ABO-I LDLT from Jan. 2012 to Dec. 2016. The ABO-I LDLT with PE (Group I; n=26) was compared to ABO-I LDLT without PE (Group II; n=43) in terms of clinical outcomes, such as iso-agglutinin titer, rejection, complication, and overall survival rate. The outcomes of both groups were compared by 1:2 propensity score matched analysis.

Results: A total of 20 patients in group I were matched to 40 patients in group II. Before desensitization, the median iso-agglutinin titersof two groups were 1:8, andthe titer levels of during follow up were not significantly different. No antibody-mediated rejection occurred in both groups. The rate of biliary stricture of group I was not significantly different from that of group II (15% vs. 20% p = 0.353). There was no statistical difference in the 3-year cumulative patientsurvival rate between two groups (p=0.167).

Conclusions:A modified protocol comprising rituximab and IVIG without PE can achieve sufficient desensitization and comparable clinical outcomes.

CITATION INFORMATION: Na B-.G., Lee E., Kim S., Park S. Modified Protocol for ABO-Incompatible Living Donor Liver Transplantation with Rituximab and Intravenous Immunoglobulin without Plasma Exchange Am J Transplant. 2017;17 (suppl 3).

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