Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation
Background. Multiple studies have failed to reveal an effective method for preventing the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LTx). A national study conducted in Japan revealed several risk factors for the recurrence after living donor LTx (LDLTx); however...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2018-02-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000760 |
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Article |
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DOAJ |
| language |
English |
| format |
Article |
| sources |
DOAJ |
| author |
Yohei Yamada, MD, PhD Ken Hoshino, MD, PhD Yasushi Fuchimoto, MD, PhD Kentaro Matsubara, MD, PhD Taizo Hibi, MD, PhD Hiroshi Yagi, MD, PhD Yuta Abe, MD, PhD Masahiro Shinoda, MD, PhD Minoru Kitago, MD, PhD Hideaki Obara, MD, PhD Takahito Yagi, MD, PhD Hideaki Okajima, MD, PhD Toshimi Kaido, MD, PhD Shinji Uemoto, MD, PhD Tatsuya Suzuki, MD, PhD Keiichi Kubota, MD, PhD Tomoharu Yoshizumi, MD Yoshihiko Maehara, MD Yukihiro Inomata, MD, PhD Yuko Kitagawa, MD, PhD Hiroto Egawa, MD, PhD Tatsuo Kuroda, MD, PhD |
| spellingShingle |
Yohei Yamada, MD, PhD Ken Hoshino, MD, PhD Yasushi Fuchimoto, MD, PhD Kentaro Matsubara, MD, PhD Taizo Hibi, MD, PhD Hiroshi Yagi, MD, PhD Yuta Abe, MD, PhD Masahiro Shinoda, MD, PhD Minoru Kitago, MD, PhD Hideaki Obara, MD, PhD Takahito Yagi, MD, PhD Hideaki Okajima, MD, PhD Toshimi Kaido, MD, PhD Shinji Uemoto, MD, PhD Tatsuya Suzuki, MD, PhD Keiichi Kubota, MD, PhD Tomoharu Yoshizumi, MD Yoshihiko Maehara, MD Yukihiro Inomata, MD, PhD Yuko Kitagawa, MD, PhD Hiroto Egawa, MD, PhD Tatsuo Kuroda, MD, PhD Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation Transplantation Direct |
| author_facet |
Yohei Yamada, MD, PhD Ken Hoshino, MD, PhD Yasushi Fuchimoto, MD, PhD Kentaro Matsubara, MD, PhD Taizo Hibi, MD, PhD Hiroshi Yagi, MD, PhD Yuta Abe, MD, PhD Masahiro Shinoda, MD, PhD Minoru Kitago, MD, PhD Hideaki Obara, MD, PhD Takahito Yagi, MD, PhD Hideaki Okajima, MD, PhD Toshimi Kaido, MD, PhD Shinji Uemoto, MD, PhD Tatsuya Suzuki, MD, PhD Keiichi Kubota, MD, PhD Tomoharu Yoshizumi, MD Yoshihiko Maehara, MD Yukihiro Inomata, MD, PhD Yuko Kitagawa, MD, PhD Hiroto Egawa, MD, PhD Tatsuo Kuroda, MD, PhD |
| author_sort |
Yohei Yamada, MD, PhD |
| title |
Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation |
| title_short |
Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation |
| title_full |
Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation |
| title_fullStr |
Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation |
| title_full_unstemmed |
Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation |
| title_sort |
rituximab induction to prevent the recurrence of psc after liver transplantation—the lessons learned from abo-incompatible living donor liver transplantation |
| publisher |
Wolters Kluwer |
| series |
Transplantation Direct |
| issn |
2373-8731 |
| publishDate |
2018-02-01 |
| description |
Background. Multiple studies have failed to reveal an effective method for preventing the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LTx). A national study conducted in Japan revealed several risk factors for the recurrence after living donor LTx (LDLTx); however, recipients of ABO-blood type incompatible (ABO-I) LTx were excluded from the previous analysis. In the present study, we investigated the efficacy of an immunosuppressive protocol in ABO-I LTx on the recurrence of PSC after LDLTx.
Methods. We conducted a national survey and analyzed the outcome of recipients who underwent ABO-I LDLTx for PSC (n = 12) between 1994 and 2010 in 9 centers and compared the outcome with that of ABO-compatible LDLTx for PSC (n = 96). The key elements of the immunosuppressive regimen in ABO-I LTx are plasma exchange sessions to remove existing antibodies, and the use of immunosuppression to control humoral immunity. Rituximab was added to the immunosuppression regimen from 2006 onward; 5 patients received rituximab perioperatively.
Results. All 7 recipients who underwent ABO-I LDLTx before 2006 (who did not receive rituximab) died of infection (n = 3), antibody-mediated rejection (n = 1), ABO-incompatibility associated cholangiopathy (n = 1) or recurrence of PSC (n = 2). In contrast, we found that all 5 recipients from 2006 (who were treated with rituximab) retained an excellent graft function for more than 7 years without any recurrence of PSC.
Conclusions. The findings of this study shed light on the efficacy of a novel strategy to prevent the recurrence of PSC and the possible mechanisms provided by rituximab treatment are discussed. |
| url |
http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000760 |
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doaj-2f9890c6882741a79afb70b3b23659ca2020-11-25T00:31:02ZengWolters KluwerTransplantation Direct2373-87312018-02-0142e34210.1097/TXD.0000000000000760201802000-0008Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver TransplantationYohei Yamada, MD, PhD0Ken Hoshino, MD, PhD1Yasushi Fuchimoto, MD, PhD2Kentaro Matsubara, MD, PhD3Taizo Hibi, MD, PhD4Hiroshi Yagi, MD, PhD5Yuta Abe, MD, PhD6Masahiro Shinoda, MD, PhD7Minoru Kitago, MD, PhD8Hideaki Obara, MD, PhD9Takahito Yagi, MD, PhD10Hideaki Okajima, MD, PhD11Toshimi Kaido, MD, PhD12Shinji Uemoto, MD, PhD13Tatsuya Suzuki, MD, PhD14Keiichi Kubota, MD, PhD15Tomoharu Yoshizumi, MD16Yoshihiko Maehara, MD17Yukihiro Inomata, MD, PhD18Yuko Kitagawa, MD, PhD19Hiroto Egawa, MD, PhD20Tatsuo Kuroda, MD, PhD211 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.3 Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan.4 Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.4 Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.4 Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.5 Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Japan.6 Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.7 Department of Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.7 Department of Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.8 Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan.2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.9 Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan.1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.Background. Multiple studies have failed to reveal an effective method for preventing the recurrence of primary sclerosing cholangitis (PSC) after liver transplantation (LTx). A national study conducted in Japan revealed several risk factors for the recurrence after living donor LTx (LDLTx); however, recipients of ABO-blood type incompatible (ABO-I) LTx were excluded from the previous analysis. In the present study, we investigated the efficacy of an immunosuppressive protocol in ABO-I LTx on the recurrence of PSC after LDLTx. Methods. We conducted a national survey and analyzed the outcome of recipients who underwent ABO-I LDLTx for PSC (n = 12) between 1994 and 2010 in 9 centers and compared the outcome with that of ABO-compatible LDLTx for PSC (n = 96). The key elements of the immunosuppressive regimen in ABO-I LTx are plasma exchange sessions to remove existing antibodies, and the use of immunosuppression to control humoral immunity. Rituximab was added to the immunosuppression regimen from 2006 onward; 5 patients received rituximab perioperatively. Results. All 7 recipients who underwent ABO-I LDLTx before 2006 (who did not receive rituximab) died of infection (n = 3), antibody-mediated rejection (n = 1), ABO-incompatibility associated cholangiopathy (n = 1) or recurrence of PSC (n = 2). In contrast, we found that all 5 recipients from 2006 (who were treated with rituximab) retained an excellent graft function for more than 7 years without any recurrence of PSC. Conclusions. The findings of this study shed light on the efficacy of a novel strategy to prevent the recurrence of PSC and the possible mechanisms provided by rituximab treatment are discussed.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000000760 |