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

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

doi:10.1097/TXD.0000000000000760

Transplantation Direct (Feb 2018)

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

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

Affiliations

Yohei Yamada, MD, PhD: 1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Ken Hoshino, MD, PhD: 1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Yasushi Fuchimoto, MD, PhD: 1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.
Kentaro Matsubara, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Taizo Hibi, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Hiroshi Yagi, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Yuta Abe, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Masahiro Shinoda, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Minoru Kitago, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Hideaki Obara, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Takahito Yagi, MD, PhD: 3 Hepato-Biliary and Pancreatic Surgery, Okayama University Hospital, Okayama, Japan.
Hideaki Okajima, MD, PhD: 4 Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Toshimi Kaido, MD, PhD: 4 Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Shinji Uemoto, MD, PhD: 4 Division of Hepato-Biliary-Pancreatic Surgery and Transplant Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Tatsuya Suzuki, MD, PhD: 5 Department of Pediatric Surgery, Fujita Health University School of Medicine, Toyoake, Japan.
Keiichi Kubota, MD, PhD: 6 Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan.
Tomoharu Yoshizumi, MD: 7 Department of Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
Yoshihiko Maehara, MD: 7 Department of Surgery, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan.
Yukihiro Inomata, MD, PhD: 8 Transplantation and Pediatric Surgery, Kumamoto University, Kumamoto, Japan.
Yuko Kitagawa, MD, PhD: 2 Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Hiroto Egawa, MD, PhD: 9 Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan.
Tatsuo Kuroda, MD, PhD: 1 Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan.

DOI: https://doi.org/10.1097/TXD.0000000000000760
Journal volume & issue: Vol. 4, no. 2
p. e342

Abstract

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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.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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