ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report
| العنوان: | ABO-incompatible living donor liver transplantation with high preoperative antibody titer: A case report |
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| المؤلفون: | Shigehito Miyagi, Kazuaki Tokodai, Atsushi Fujio, Takashi Kamei, Michiaki Unno, Yoshikatsu Saitoh |
| المصدر: | International Journal of Surgery Case Reports |
| بيانات النشر: | Elsevier BV, 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | medicine.medical_specialty, biology, business.industry, Living donor liver transplantation, Antibody titer, Case Report, medicine.disease, Gastroenterology, High antibody titer, Tacrolimus, Transplantation, ABO-incompatible, Antigen, Biliary atresia, Antibody-mediated rejection, ABO blood group system, Internal medicine, medicine, biology.protein, Surgery, Rituximab, Antibody, business, medicine.drug |
| الوصف: | Introduction and importance ABO-incompatible living donor liver transplantation (ABOi-LDLT) is essential for expanding the donor pool. ABOi-LDLT prognosis has improved since desensitization treatment with rituximab; however, patients with high antibody titers are considered to be at high risk of antibody mediated rejection (AMR). Nevertheless, the preoperative antibody titer cutoff levels that preclude ABOi-LDLT have not yet been determined. In this study, the highest preoperative antibody titer was 1:4096, and the recipient had good outcomes. There has been only one report of good outcomes with a preoperative antibody titer of more than 1:4096. We hypothesized that high preoperative antibody titers in ABOi-LDLT may not be associated with AMR in protocols involving rituximab. Case presentation The recipient was a 22-year-old man with biliary atresia and underwent ABOi-LDLT (B to O). We administered 500 mg of rituximab 14 days prior and then 300 mg of rituximab one day prior to ABOi-LDLT. The recipients preoperative IgG antibody titer was 1:4096. Postoperative immunosuppressive protocol involved steroids, tacrolimus, and mycophenolate mofetil. The patient had satisfactory graft function three years following ABOi-LDLT. Clinical discussion The antibody that is responsible for posttransplant AMR should be newly synthesized after transplantation as a result of sensitization by antigens on the vascular endothelial cells of the graft. In ABOi-LDLT, natural antibodies may not cause AMR. Conclusions The most important factor for preventing AMR in recipients undergoing ABOi-LDLT is the suppression of de novo antibodies. High preoperative antibody titers may not necessarily preclude ABOi-LDLT, provided that rituximab is used in desensitization. Highlights • Patients with high antibody titers are considered to be at high risk of AMR. • Although his preoperative antibody titer was 1:4096, the patient had good outcomes. • De novo antibodies are strongly suppressed by rituximab desensitization. • High preoperative antibody titers may not limit ABOi-LDLT if rituximab is used. |
| تدمد: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2021.106260 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::b4d972b1affd08aecd733ccc50751f65 https://doi.org/10.1016/j.ijscr.2021.106260 |
| Rights: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....b4d972b1affd08aecd733ccc50751f65 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 22102612 |
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| DOI: | 10.1016/j.ijscr.2021.106260 |