Prophylactic use of anti-CD20 monoclonal antibody in ABO-incompatible liver transplantation

Local infusion of immunosuppression via portal vein catheter and/or hepatic arterial catheter combined with splenectomy has been shown an effective therapy to prevent fatal humoral rejection in ABO-incompatible living donor liver transplantation (LDLT). However, portal vein thrombosis and frequent infectious complications were the significant adverse effects. In this series, anti-CD20 monoclonal antibody (Rituximab) was introduced in stead of portal vein infusion and splenectomy and the efficacy and the timing of Rituximab administration combined with hepatic arterial infusion was examined in 18 patients with the age range of 16 to 68 years (rescue treatment: n = 3, preemptive treatment: n = 3, prophylactic treatment: n = 12) with ABO-incompatible LDLT. Fatal humoral rejection occurred in 2 out of 3 patients with rescue treatment and in 1 out or 3 patients with preemptive treatment, while fatal rejection did not occur in 12 patients with the prophylactic treatment. The frequency of humoral rejection was low (25%) and all humoral rejections (n = 3) were treatable in the prophylactic treatment. The prophylactic use of Rituximab was markedly effective in ABO-incompatible LDLT.