Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer,Model for End-Stage Liver Disease Score,and Graft Liver Volume |
| |
| Authors: | Geun Hong Nam-Joon Yi Suk-won Suh Tae Yoo Hyeyoung Kim Min-Su Park YoungRok Choi Kyungbun Lee Kwang-Woong Lee Myoung Hee Park Kyung-Suk Suh |
| |
| Affiliation: | 1.Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.;2.Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.;3.Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea. |
| |
| Abstract: | Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe.Graphical Abstract | |
| Keywords: | Blood Grouping and Crossmatching Desensitization Graft Rejection Living Donors Liver Transplantation |
|
|
