Splenectomy does not offer immunological benefits in ABO-incompatible liver transplantation with a preoperative rituximab.
Transplantation
; 93(1): 99-105, 2012 Jan 15.
Article
en En
| MEDLINE
| ID: mdl-22094955
ABSTRACT
BACKGROUND:
Preformed anti-ABO antibodies are primarily responsible for antibody-mediated rejection (AMR) after ABO-incompatible (ABO-I) liver transplantation (LT) resulting in lethal hepatic necrosis and biliary complications. Splenectomy, an integral part of protocol for ABO-I LT, decreases anti-ABO antibodies. With the preoperative rituximab prophylaxis, role of the splenectomy for ABO-I LT is now under debate. We investigated the necessity of splenectomy by retrospective analyses of the short-term anti-ABO antibody response and long-term outcomes of ABO-I LT.METHODS:
Thirty-seven ABO-I LTs performed from May 2006 through July 2009, at Kyoto University Hospital, Kyoto, Japan, were retrospectively analyzed. Twenty-seven patients who underwent splenectomy (splenectomy group) received 329.6 ± 35.8 mg rituximab 17.7 ± 11.9 days before living donor LT. Ten patients without splenectomy (nonsplenectomy group) received 320.0 ± 10.3 mg rituximab 26.6 ± 21.3 days before transplantation. All patients received a posttransplant hepatic artery infusion with prostaglandin E1 and methylprednisolone. Perioperative anti-ABO immunoglobulin M and immunoglobulin G antibody titers, rejections, biliary complications, infections, and survival results were compared.RESULTS:
Preoperative rituximab with plasma exchange effectively reduced anti-ABO antibodies in both patient groups at the time of LT. There was no statistically significant difference observed in anti-ABO immunoglobulin M and immunoglobulin G antibody titers between the "splenectomy" and "nonsplenectomy" groups during the initial 8 weeks. The clinical outcomes, including AMR, biliary complications, infections, and survival, were similar in both the groups.CONCLUSIONS:
Preoperative rituximab effectively decreased the anti-ABO antibodies sufficiently to prevent the AMR irrespective of splenectomy. Splenectomy does not offer any immunological benefit in ABO-I LT with preoperative rituximab.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Esplenectomía
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Incompatibilidad de Grupos Sanguíneos
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Sistema del Grupo Sanguíneo ABO
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Trasplante de Hígado
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Anticuerpos Monoclonales de Origen Murino
/
Rechazo de Injerto
Tipo de estudio:
Guideline
/
Incidence_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Transplantation
Año:
2012
Tipo del documento:
Article
País de afiliación:
Japón