Living Donor Liver Transplantation in Patients with Preformed Donor-Specific Anti-Human Leukocyte Antigen Antibodies Using Preoperative Desensitization Therapy According to Intensity of Donor-Specific Antibodies: A Single-Center Study.

IF 1.1 4区 医学 Q3 SURGERY Annals of Transplantation Pub Date : 2023-09-12 DOI:10.12659/AOT.941346
Kohei Ogawa, Kei Tamura, Katsunori Sakamoto, Naotake Funamizu, Masahiko Honjo, Mikiya Shine, Yusuke Nishi, Tomoyuki Nagaoka, Chihiro Ito, Miku Iwata, Mio Uraoka, Yasutsugu Takada
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Abstract

BACKGROUND In liver transplantation (LT), preoperative desensitization therapy is considered necessary in patients positive for donor-specific anti-human leukocyte antigen antibodies (DSAs). However, the relationship between DSA intensity and the necessary desensitization therapy is unclear. MATERIAL AND METHODS A total of 37 adult living donor (LD) LTs performed between January 2016 and March 2022 were examined. Mycophenolate mofetil (MMF) was administered preoperatively in DSA-positive cases with positive lymphocyte cross-matching who underwent LDLT. In those with strongly positive DSA (mean fluorescence intensity 10 000), rituximab was administered 2 weeks before LDLT in addition to MMF. Cross-reactive epitope group antigen (CREG)-alone-positive cases were also treated with preoperative MMF when lymphocyte cross-matching was positive. RESULTS Of the 37 patients, 9 were DSA-positive, 7 were CREG-alone-positive, and the others were double-negative. Of 9 DSA-positive cases, desensitization therapy was performed in 7, among which rituximab administration was performed in 3 strongly DSA-positive cases. Of 7 CREG-alone-positive cases, 2 were lymphocyte cross-match-positive and underwent desensitization therapy. The 1-year survival rate was 100% in both DSA- and CREG-alone-positive cases. The frequency of T-cell mediated rejection in DSA-positive, CREG-alone-positive, and double-negative cases was 22%, 43%, and 29%, respectively, with no significant difference. Antibody-mediated rejection occurred in only 1 patient, who was strongly DSA-positive and blood-group incompatible. There was also no significant difference among the 3 groups in terms of the frequency of biliary complications or 90-day mortality. CONCLUSIONS Satisfactory LDLT results were achieved in DSA- and CREG-alone-positive cases following desensitization therapy.

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活体肝移植中预先形成的供体特异性抗人白细胞抗原抗体患者根据供体特异性抗体强度进行术前脱敏治疗:一项单中心研究
背景在肝移植(LT)中,对于供体特异性抗人白细胞抗原抗体(dsa)阳性的患者,术前脱敏治疗被认为是必要的。然而,DSA强度与必要的脱敏治疗之间的关系尚不清楚。材料与方法对2016年1月至2022年3月期间进行的37例成人活体供体(LD) LTs进行检查。dsa阳性,淋巴细胞交叉配型阳性,行LDLT的患者术前给予霉酚酸酯(MMF)。在DSA阳性(平均荧光强度10000)的患者中,除了MMF外,还在LDLT前2周给予利妥昔单抗。交叉反应性表位群抗原(CREG)单独阳性的患者,当淋巴细胞交叉匹配阳性时,也在术前接受MMF治疗。结果37例患者中,dsa阳性9例,单独creg阳性7例,双阴性7例。9例dsa阳性患者中,7例行脱敏治疗,其中3例dsa强阳性患者行利妥昔单抗治疗。7例单独creg阳性病例中,2例淋巴细胞交叉配型阳性,接受脱敏治疗。DSA阳性和单独creg阳性病例的1年生存率均为100%。dsa阳性、creg单独阳性和双阴性病例中t细胞介导的排斥反应频率分别为22%、43%和29%,差异无统计学意义。抗体介导的排斥反应仅发生在1例患者中,该患者dsa阳性且血型不相容。在胆道并发症发生频率和90天死亡率方面,三组间也无显著差异。结论DSA阳性和单独creg阳性患者脱敏治疗后LDLT效果满意。
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来源期刊
CiteScore
2.50
自引率
0.00%
发文量
79
审稿时长
>12 weeks
期刊介绍: Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation. Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time to first decision is around 3-4 weeks. Time to publication of accepted manuscripts continues to be shortened, with the Editorial team committed to a goal of 3 months from acceptance to publication. Expert reseachers and clinicians from around the world contribute original Articles, Review Papers, Case Reports and Special Reports in every pertinent specialty, providing a lot of arguments for discussion of exciting developments and controversies in the field.
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