Abstract
In ABO-incompatible living donor liver transplantation (LDLT), antibody-mediated rejection (AMR) due to anti-ABO antibodies plays a critical role on the outcome of the transplantation. Recently, rituximab has been used for the prophylaxis of AMR. From the viewpoint of transfusion medicine, we retrospectively evaluated the effect of rituximab prophylaxis on the amount of FFP used in plasma exchange (PE) for anti-ABO antibodies in ABO-incompatible LDLT. A total of 17 patients were divided into 3 groups: Group I (8 patients, no prophylaxis), Group II-1 (3 patients, rituximab prophylaxis one week before transplantation), and Group II-2 (6 patients, rituximab prophylaxis 2 weeks before transplantation). In Group I, 5 of 8 patients showed elevated anti-ABO antibody titers after LDLT compared with before, while in Group II, no patients showed any elevation. PE was performed after LDLT in 4 of 8 patients in Group I and 2 of 3 patients in Group II-1, and the average amount of FFP used for PE was 122 units (1 unit of FFP in Japan is 120 ml) and 187 units in Groups I and II-1, respectively. In sharp contrast, PE was not performed in any Group II-2 patients after LDLT. Our data suggest that rituximab prophylaxis 2 weeks before LDLT may be effective in reducing the amount of FFP used in ABO-incompatible LDLT.
