Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation
ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) can be performed successfully. However, anti-ABO isoagglutinin rebound may cause antibody-mediated rejection (AMR) and graft loss. The risk threshold of isoagglutinin rebound is still not defined. 76 ABO-I LDLT recipients were divide...
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| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/11/12/1300 |
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| author | Wei-Chen Lee Chen-Fang Lee Tsung-Han Wu Hao-Chien Hung Jin-Chiao Lee Yu-Chao Wang Chih-Hsien Cheng Ting-Jung Wu Hong-Shiue Chou Kun-Ming Chan |
| author_facet | Wei-Chen Lee Chen-Fang Lee Tsung-Han Wu Hao-Chien Hung Jin-Chiao Lee Yu-Chao Wang Chih-Hsien Cheng Ting-Jung Wu Hong-Shiue Chou Kun-Ming Chan |
| author_sort | Wei-Chen Lee |
| collection | DOAJ |
| description | ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) can be performed successfully. However, anti-ABO isoagglutinin rebound may cause antibody-mediated rejection (AMR) and graft loss. The risk threshold of isoagglutinin rebound is still not defined. 76 ABO-I LDLT recipients were divided into group A (<i>n</i> = 56) with low isoagglutinin titers (<1:256), and group B (<i>n</i> = 20) with high isoagglutinin titers (≥1:256), at initial assessment for liver transplantation. The last 12 patients in group B received a modified desensitization regimen by adding bortezomib to deplete plasma cells. Six (10.7%) patients in group A and 10 (50.0%) patients in group B had postoperative isoagglutinin rebound (<i>p</i> < 0.001). Three patients (5.54%) in group A and two patients (10%) in group B developed clinical AMR (<i>p</i> = 0.602). The cutoff value of postoperative isoagglutinin rebound to cause clinical AMR was ≥1:1024. Among the 12 patients in group B with bortezomib administration, isoagglutinin rebounded up to 1:128 only, and no clinical AMR occurred. In conclusion, the patients with high isoagglutinin titers had a higher rate of postoperative isoagglutinin rebound. Isoagglutinin rebound ≥1:1024 is risky for developing clinical AMR. Adding bortezomib into the desensitization regimen may mitigate isoagglutinin rebound, and avoid clinical AMR. |
| first_indexed | 2024-03-10T03:46:03Z |
| format | Article |
| id | doaj.art-92bfe58994a5463c93ad0f7d5960997d |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-10T03:46:03Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-92bfe58994a5463c93ad0f7d5960997d2023-11-23T09:07:36ZengMDPI AGJournal of Personalized Medicine2075-44262021-12-011112130010.3390/jpm11121300Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver TransplantationWei-Chen Lee0Chen-Fang Lee1Tsung-Han Wu2Hao-Chien Hung3Jin-Chiao Lee4Yu-Chao Wang5Chih-Hsien Cheng6Ting-Jung Wu7Hong-Shiue Chou8Kun-Ming Chan9Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanDivision of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou 33357, TaiwanABO-incompatible (ABO-I) living donor liver transplantation (LDLT) can be performed successfully. However, anti-ABO isoagglutinin rebound may cause antibody-mediated rejection (AMR) and graft loss. The risk threshold of isoagglutinin rebound is still not defined. 76 ABO-I LDLT recipients were divided into group A (<i>n</i> = 56) with low isoagglutinin titers (<1:256), and group B (<i>n</i> = 20) with high isoagglutinin titers (≥1:256), at initial assessment for liver transplantation. The last 12 patients in group B received a modified desensitization regimen by adding bortezomib to deplete plasma cells. Six (10.7%) patients in group A and 10 (50.0%) patients in group B had postoperative isoagglutinin rebound (<i>p</i> < 0.001). Three patients (5.54%) in group A and two patients (10%) in group B developed clinical AMR (<i>p</i> = 0.602). The cutoff value of postoperative isoagglutinin rebound to cause clinical AMR was ≥1:1024. Among the 12 patients in group B with bortezomib administration, isoagglutinin rebounded up to 1:128 only, and no clinical AMR occurred. In conclusion, the patients with high isoagglutinin titers had a higher rate of postoperative isoagglutinin rebound. Isoagglutinin rebound ≥1:1024 is risky for developing clinical AMR. Adding bortezomib into the desensitization regimen may mitigate isoagglutinin rebound, and avoid clinical AMR.https://www.mdpi.com/2075-4426/11/12/1300ABO-incompatibilityliver transplantationrituximabbortezomibcase series |
| spellingShingle | Wei-Chen Lee Chen-Fang Lee Tsung-Han Wu Hao-Chien Hung Jin-Chiao Lee Yu-Chao Wang Chih-Hsien Cheng Ting-Jung Wu Hong-Shiue Chou Kun-Ming Chan Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation Journal of Personalized Medicine ABO-incompatibility liver transplantation rituximab bortezomib case series |
| title | Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation |
| title_full | Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation |
| title_fullStr | Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation |
| title_full_unstemmed | Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation |
| title_short | Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation |
| title_sort | clinical relevance of isoagglutinin rebound in adult abo incompatible living donor liver transplantation |
| topic | ABO-incompatibility liver transplantation rituximab bortezomib case series |
| url | https://www.mdpi.com/2075-4426/11/12/1300 |
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