Seung Duk Lee1, Seong Hoon Kim2, Sun-Young Kong3, Young-Kyu Kim4, Sang-Jae Park1. 1. Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. 2. Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. Electronic address: kshlj@hanmail.net. 3. Department of Laboratory Medicine, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. 4. Department of Surgery, Graduate School of Medicine, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea.
Abstract
BACKGROUND: The kinetics of isoagglutinin titers and lymphocyte subpopulations including B, T, and natural killer (NK) cells after ABO incompatible (ABO-I) living donor liver transplantation (LDLT) have not been evaluated. METHODS: From January 2012 to July 2013, consecutive ABO-I LDLT patients were enrolled at the National Cancer Center. Our desensitizing protocol included rituximab, plasma exchanges, basiliximab, and intravenous immune globulin without splenectomy. RESULTS: Twenty patients (14 males, 6 females) underwent ABO-I LDLT due to HCC (n=15) or liver cirrhosis (n=5). There was no hyperacute and antibody-mediated rejection. The isoagglutinin titers were effectively lowered less than 1:16 before operation. CD 19+ B cells were rapidly eliminated after rituximab and suppressed during 6months postoperatively. CD3+ and CD4+ T cells were elevated higher than CD8+ T cells. CD4/CD8 ratio was increased during first 1month postoperatively and decreased thereafter. CD16+CD56+ NK cells were lowered and restored after 4months of LDLT. Among 15 patients with HCC, 5 patients (33.3%) experienced early tumor recurrence (1/8 within Milan and 4/7 beyond Milan). CONCLUSIONS: Our protocol showed effective results in preventing antibody-mediated rejection and suppressing B lymphocytes. Application to advanced hepatocellular carcinoma should be considered due to decreased natural immunity after ABO-I LDLT.
BACKGROUND: The kinetics of isoagglutinin titers and lymphocyte subpopulations including B, T, and natural killer (NK) cells after ABO incompatible (ABO-I) living donor liver transplantation (LDLT) have not been evaluated. METHODS: From January 2012 to July 2013, consecutive ABO-I LDLT patients were enrolled at the National Cancer Center. Our desensitizing protocol included rituximab, plasma exchanges, basiliximab, and intravenous immune globulin without splenectomy. RESULTS: Twenty patients (14 males, 6 females) underwent ABO-I LDLT due to HCC (n=15) or liver cirrhosis (n=5). There was no hyperacute and antibody-mediated rejection. The isoagglutinin titers were effectively lowered less than 1:16 before operation. CD 19+ B cells were rapidly eliminated after rituximab and suppressed during 6months postoperatively. CD3+ and CD4+ T cells were elevated higher than CD8+ T cells. CD4/CD8 ratio was increased during first 1month postoperatively and decreased thereafter. CD16+CD56+ NK cells were lowered and restored after 4months of LDLT. Among 15 patients with HCC, 5 patients (33.3%) experienced early tumor recurrence (1/8 within Milan and 4/7 beyond Milan). CONCLUSIONS: Our protocol showed effective results in preventing antibody-mediated rejection and suppressing B lymphocytes. Application to advanced hepatocellular carcinoma should be considered due to decreased natural immunity after ABO-I LDLT.
Authors: Krupa R Mysore; Ryan W Himes; Abbas Rana; Jun Teruya; Moreshwar S Desai; Poyyapakkam R Srivaths; Kimberly Zaruca; Andrea Calvert; Danielle Guffey; Charles G Minard; Eda Morita; Lisa Hensch; Michael Losos; Vadim Kostousov; Shiu-Ki Rocky Hui; Jordan S Orange; John A Goss; Sarah K Nicholas Journal: Pediatr Transplant Date: 2018-08-02
Authors: Silke Rummler; Astrid Bauschke; Erik Bärthel; Heike Jütte; Katrin Maier; Patrice Ziehm; Christina Malessa; Utz Settmacher Journal: World J Transplant Date: 2016-09-24