Kinetics of B, T, NK lymphocytes and isoagglutinin titers in ABO incompatible living donor liver transplantation using rituximab and basiliximab

• We analyzed the kinetics of T, B, and NK cells after ABO incompatible living donor liver transplantation.
• The isoagglutinin titers were effectively lowered less than 1:16 perioperatively.
• CD 19 + B cells were rapidly eliminated after rituximab administration
• CD16 + CD56 + NK cells were lower and restored after 4 months of transplantation.
• Early recurrence of HCC after ABO incompatible liver transplantation was shown in advanced patients.

BackgroundThe kinetics of isoagglutinin titers and lymphocyte subpopulations including B, T, and natural killer (NK) cells after ABO incompatible (ABO-I) living donor liver transplantation (LDLT) have not been evaluated.MethodsFrom January 2012 to July 2013, consecutive ABO-I LDLT patients were enrolled at the National Cancer Center. Our desensitizing protocol included rituximab, plasma exchanges, basiliximab, and intravenous immune globulin without splenectomy.ResultsTwenty patients (14 males, 6 females) underwent ABO-I LDLT due to HCC (n = 15) or liver cirrhosis (n = 5). There was no hyperacute and antibody-mediated rejection. The isoagglutinin titers were effectively lowered less than 1:16 before operation. CD 19 + B cells were rapidly eliminated after rituximab and suppressed during 6 months postoperatively. CD3 + and CD4 + T cells were elevated higher than CD8 + T cells. CD4/CD8 ratio was increased during first 1 month postoperatively and decreased thereafter. CD16 + CD56 + NK cells were lowered and restored after 4 months of LDLT. Among 15 patients with HCC, 5 patients (33.3%) experienced early tumor recurrence (1/8 within Milan and 4/7 beyond Milan).ConclusionsOur protocol showed effective results in preventing antibody-mediated rejection and suppressing B lymphocytes. Application to advanced hepatocellular carcinoma should be considered due to decreased natural immunity after ABO-I LDLT.