Rituximab Induction to Prevent the Recurrence of PSC After Liver Transplantation—The Lessons Learned From ABO-Incompatible Living Donor Liver Transplantation

• Published in: Transplantation direct 2018-02, Vol.4 (2), p.e342-e342
• Main Authors: Yamada, Yohei, Hoshino, Ken, Fuchimoto, Yasushi, Matsubara, Kentaro, Hibi, Taizo, Yagi, Hiroshi, Abe, Yuta, Shinoda, Masahiro, Kitago, Minoru, Obara, Hideaki, Yagi, Takahito, Okajima, Hideaki, Kaido, Toshimi, Uemoto, Shinji, Suzuki, Tatsuya, Kubota, Keiichi, Yoshizumi, Tomoharu, Maehara, Yoshihiko, Inomata, Yukihiro, Kitagawa, Yuko, Egawa, Hiroto, Kuroda, Tatsuo
• Format: Article
• Language: English
• Subjects: Liver Transplantation
• ISSN: 2373-8731; 2373-8731
• DOI: 10.1097/TXD.0000000000000760

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. 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. 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. 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.