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ABO-incompatible liver transplantation using only rituximab for patients with low anti-ABO antibody titer
Ann Hepatobiliary Pancreat Surg 2019 Aug;23(3):211-8
Published online August 31, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Boram Lee1, YoungRok Choi1, Ho-Seong Han1, Yoo-Seok Yoon1, Jai Young Cho1,Sook-Hyang Jeong2, Jin-Wook Kim2, Eun Sun Jang2, and Soomin Ahn3

Departments of 1Surgery, 2Medicine, and 3Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
Received November 22, 2018; Revised March 17, 2019; Accepted March 29, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Graft survival after ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has increaseddue to advances in desensitization methods. We analyzed early outcomes following ABOi LDLT using only rituximabwithout any additional desensitization methods in recipients with low anti-ABO antibody titers (≤1:32).
Methods: Tenadult patients underwent ABOi LDLT between September 2014 and December 2016. All patients were administereda single dose of rituximab (300 mg/m2) prior to LDLT. Three patients with baseline anti-ABO titer >1:32 underwentmultiple sessions of plasmapheresis to reduce titers to <1:32 (rituximab+plasmapheresis, RP). Seven patients with lowanti-ABO titer (≤1:32) did not undergo plasmapheresis (rituximab-only, RO). ABO-compatible LDLT patients duringthe same period were included for comparison (n=22).
Results: Post-transplantation titers were significantly lower inthe RO than in the RP and showed no rebound rise (POD7 1.14±0.38 vs 28.0±31.7, p=0.04), (POD30 1.26±0.45 vs108±107, p=0.02). There were no significant differences in rejection, biliary complications and infection between groups.There were no significant differences in outcome between the RO group and ABO-compatible except for infection.
Conclusions: This study shows that recipients with low baseline anti-ABO antibody titer (≤1:32) can undergo ABOiLDLT using conventional immunosuppression and rituximab alone.
Keywords : Antibody mediated rejection; Anti-ABO antibody titer; Plasmapheresis; Rituximab; Liver transplant


August 2019, 23 (3)