Rituximab made a great progress on outcomes of ABO-incompatible living donor liver transplantation (ABO-I LDLT). Although Japanese multicenter study group published efficacy and safety of Rituximab in 381adult patients undergoing ABO-I LDLT (Am J Transplant. 2014; 14: 102), the best regimen is not presented yet because of learning curve and heterogeneity of center based regimes. In 2013, 15 Japanese centers tried to apply a common regimen in which Rituximab with a dose of 375mg/m2 or 500mg/body (regular dose) is administrated 2 weeks before transplantation. Preoperative intravenous immune globulin (IVIG) or T-cell targeting induction therapy was not applied. The dose was decreased according to clinical conditions in 5 patients and the period between the Rituximab administration and LT was modified because of clinical conditions and policy of operation schedule in each center in 9 patients. Thirty-three adult patients underwent ABO-I LDLT from January to December in 2013. Donors were sons or daughters in 12, spouses in 10, parents in 5, siblings in 3 and others in 3. MELD ranged from 9 to 32 with the median of 14. Graft recipient weight ratio ranged from 0.48 to 1.33. The patients were divided in two groups; patients with the regular dose of Rituximab 10 day before LT or earlier (matched group: n=20) and patients with the less dose than the regular dose and/or later than 10 days (mismatched group: n=13). One year patient survival of the whole 33 patients was 80.8%. Antibody mediated rejection (AMR) occurred in 4 patients and 3 of them died. Incidence of AMR was 0% and 31% (p=0.004), that of severe bacterial infection was 15% and 46% (n.s.), that of severe fungal infection was 0% and 8% (n.s.), and that of viral infection was 55% and 46% (n.s.), and 1 year patient survival was 95% and 59% (p=0.019) in matched group and mismatched group, respectively. In conclusion, Rituximab with regular dose 2 weeks before transplantation without preoperative IVIG or T-cell targeting induction therapy was safe and effective in adult ABO-I LT. Acknowledgement: Nagoya Univ., Tohoku Univ., Nagasaki Univ., Osaka Univ., Mie Univ., Hiroshima Univ., Keio Univ., Kumamoto Univ., Kyushu Univ., Kyoto Pref. Med. Univ., Kyoto Univ., Iwate Univ., Okayama Univ., Ehime Univ., and Tokyo Women's Med. Univ..

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