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Updated: Feb 20, 2026
In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients
Published on: August 12, 2017
A simplified protocol using rituximab and immunoglobulin for ABO-incompatible low-titre living donor liver
Seong Hoon Kim1, Eung Chang Lee1, Jae Ryong Shim1
1Organ Transplantation Center/Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Korea.
Background & Aims:
No consensus has been reached regarding optimal treatment strategies for ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). We introduce a simplified protocol using rituximab and intravenous immunoglobulin (IVIG).
Methods:
Data were analysed on adult patients who underwent ABO-I LDLT of which protocol added rituximab (300 mg/m2 ) before surgery and IVIG (0.8 g/kg) on post-operative days 1 and 4 to the conventional immunosuppressive regimen used in ABO-compatible (ABO-C) LDLT, without plasmapheresis, splenectomy or graft local infusion. The outcomes were compared with those of ABO-C LDLT by 1:2 propensity score-matched analysis.
Results:
Consecutive 43 ABO-I LDLT patients were identified between 2014 and 2016. Before desensitization, the median isoagglutinin titre was 1:8 (range, 1:2-1:64). The titre was reduced to 4 (range, 0-16) at the time of LDLT. None showed a rebound rise of isoagglutinin titres. No antibody-mediated rejection occurred. Biliary stricture was the most common complication with an incidence of 30.2%. A comparator group of 86 ABO-C LDLT patients were selected. There was no statistical difference in the overall complication rate including acute cellular rejection, biliary complications and infection between ABO-I and ABO-C groups. The 3-year cumulative patient survival rates in the ABO-I and ABO-C groups were 82.4% and 85.9% respectively (P = .115).
Conclusions:
A simplified protocol using rituximab and IVIG for ABO-I LDLT was safe and effective in achieving sufficient desensitization and comparable outcomes in patients with the titre no higher than 1:64.
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