Background: Adult ABO-incompatible (ABOi) living donor liver transplantation has been performed for acute liver failure or end stage liver diseases when deceased liver allografts or ABO-compatible liver donors are not available. Before transplantation, B-cells are depleted and anti-blood type isoagglutinin are decreased to guarantee the success of adult ABOi living donor liver transplantation. However, long-term immunological profiled for these patients are not clear.

Patients and methods: Eighty adult patients with ABOi living donor liver transplantation were included in this study. The preparation regimen for ABOi liver transplantation includes rituximab administration and plasma exchange to achieve IgG and IgM isoagglutinin ≤64. After transplantation, the B-cell population and isoagglutinin were measured periodically and the data were collected.

Results: Eighty patients were included in this study. Median (interquartile range, IR) age was 54 (11) years. The median (IR) MELD scores was 14 (9). Among the patients, 41.25% was A to O, 25% was B-O, 8.75% was A to B, 5% was B to A, and 20% was AB to A, B or O. Before transplantation, the median (range) IgG isoagglutinin titers were 128 (8-2048). In the first month after transplantation, 5 (6.25%) patients have experienced IgG isoagglutinin titers ≥512, 8 (10%) patients had IgG isoagglutinin titer between 128-256, and all other patients had IgG isoagglutinin titer ≤64. The B-cell population was 0.25±0.26% at 1 month, 1.05±1.82% at 3 month, 5.30±7.72% at 6 month, 7.72±7.63% at 1 year and 11.78±5.70% at 3 years. These data showed that B-cell population recovered at postoperative 6-12 months after B-cells were depleted by rituximab before transplantation. Although B-cell population recovered, isoagglutinin remained and persisted low after transplantation. All 5 patients with IgG isoagglutinin titers ≥512 had antibody-mediated complications.

Conclusion: B-cells were depleted and isoagglutinin was washed out to successfully perform adult ABOi living donor liver transplantation. B-cells would recover 6-12 months after rituximab application. But, anti-blood type isoagglutinin remained and persisted low in a long run.

CITATION INFORMATION: Wu T-.J., Wang Y-.C., Cheng C-.H., Wu T-.H., Lee C-.F., Chou H., Chan K-.M., Lee W-.C. Postoperative Immunological Profiles of Adult ABO-Incompatible Living Donor Liver Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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