Clinical effect of perioperative intravenous immunoglobulin on ABO incompatible liver transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Jinping ,  ZHU Zhijun , SUN Liying , WEI Lin , QU Wei , ZENG Zhigui , ZHANG Haiming , LIU Ying , WANG Jun , TAN Yule

Liver Transplantation Center, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, P. R. China;

Corresponding author：

ZHU Zhijun, Email: zhu-zhijun@outlook.com

Keywords：

pediatric liver transplantation; ABO-incompatible; immunoglobulin

DOI：

10.7507/1007-9424.202104105

Video：

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Objective To investigate the effect of perioperative intravenous immunoglobulin (IVIG) on the reduction of blood group antibody titer and prognosis in children with ABO incompatible (ABO-I) liver transplantation.Methods A retrospective study was conducted in 20 children undergoing ABO-I liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to March 2020. The changes of blood group antibody titer, alanine aminotransferase, and total bilirubin before and after operation, as well as survival rate were analyzed after intravenous IVIG during perioperative period.Results After ABO-I liver transplantation, the 1-year survival rate of 20 patients was 100%, and 1 case (5%) developed immune rejection. Compared with before operation, on the day of operation, IgM blood group antibody titer did not change in 4 cases (20%), increased in 1 case (5%), and decreased in 15 cases (75%); in one week after operation: 12 cases (60%) decreased, 5 cases (25%) increased, and 3 cases (15%) remained unchanged; in one month after operation: 18 cases (90%) decreased , 2 cases (10%) remained unchanged. Compared with before operation, the titer of IgG blood group antibody increased in 2 cases (10%), remained unchanged in 6 cases (30%), and decreased in 12 cases (60%); in one week after operation: 4 cases (20%) increased, 4 cases (20%) remained unchanged, and 12 cases (60%) decreased; in one month after operation: 3 cases (15%) increased, 4 cases (20%) remained unchanged, and 13 cases (65%) decreased. The levels of alanine aminotransferase and total bilirubin in 1 month after operation were lower than those on the day of operation.Conclusion The effect of IVIG on reducing blood group antibody titer in children after ABO-I liver transplantation is not obvious, and its actual clinical effect needs to befurther confirmed.

Citation： ZHANG Jinping, ZHU Zhijun, SUN Liying, WEI Lin, QU Wei, ZENG Zhigui, ZHANG Haiming, LIU Ying, WANG Jun, TAN Yule. Clinical effect of perioperative intravenous immunoglobulin on ABO incompatible liver transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(8): 992-996. doi: 10.7507/1007-9424.202104105 Copy

1.	Farges O, Kalil AN, Samuel D, et al. The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients. Transplantation, 1995, 59(8): 1124-1133.
2.	Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers. Lancet, 1990, 336(8714): 519-523.
3.	Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier. Transplantation, 1994, 58(5): 543-547.
4.	Urbani L, Mazzoni A, Bianco I, et al. The role of immunomodulation in ABO-incompatible adult liver transplant recipients. J Clin Apher, 2008, 23(2): 55-62.
5.	Ikegami T, Taketomi A, Soejima Y, et al. Rituximab, IVIG, and plasma exchange without graft local infusion treatment: a new protocol in ABO incompatible living donor liver transplantation. Transplantation, 2009, 88(3): 303-307.
6.	Egawa H, Teramukai S, Haga H, et al. Present status of ABO-incompatible living donor liver transplantation in Japan. Hepatology, 2008, 47(1): 143-152.
7.	Kim JD, Choi DL, Kim SG, et al. Single-center experience of ABO-incompatible living-donor liver transplantation with a new simplified intravenous immunoglobulin protocol: A propensity score-matching analysis. Transplant Proc, 2016, 48(4): 1134-1138.
8.	金磊, 殷浩, 傅宏, 等. 跨血型肝移植26例经验. 中华肝胆外科杂志, 2014, 20(10): 705-709.
9.	Kazatchkine MD, Kaveri SV. Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med, 2001, 345(10): 747-755.
10.	Watanabe J, Scornik JC. IVIG and HLA antibodies. Evidence for inhibition of complement activation but not for anti-idiotypic activity. Am J Transplant, 2005, 5(11): 2786-2790.
11.	Basta M, Van Goor F, Luccioli S, et al. F(ab)′ 2-mediated neutralization of C3a and C5a anaphylatoxins: a novel effector function of immunoglobulins. Nat Med, 2003, 9(4): 431-438.
12.	Jordan SC, Vo A, Tyan D, et al. Desensitization therapy with intravenous gammaglobulin (IVIG): applications in solid organ transplantation. Trans Am Clin Climatol Assoc, 2006, 117: 199-211.
13.	Samuelsson A, Towers TL, Ravetch JV. Anti-inflammatory activity of IVIG mediated through the inhibitory Fc receptor. Science, 2001, 291(5503): 484-486.
14.	Kim JD, Choi DL, Han YS. Fourteen successful consecutive cases of ABO-incompatible living donor liver transplantation: new simplified intravenous immunoglobulin protocol without local infusion therapy. Transplant Proc, 2014, 46(3): 754-757.
15.	Gelfand EW. Critical decisions in selecting an intravenous immunoglobulin product. J Infus Nurs, 2005, 28(6): 366-374.
16.	Welsh KJ, Bai Y. Therapeutic plasma exchange as a therapeutic modality for the treatment of IVIG complications. J Clin Apher, 2015, 30(6): 371-374.
17.	Shen T, Lin BY, Jia JJ, et al. A modified protocol with rituximab and intravenous immunoglobulin in emergent ABO-incompatible liver transplantation for acute liver failure. Hepatobiliary Pancreat Dis Int, 2014, 13(4): 395-401.
18.	Lee CF, Cheng CH, Wang YC, et al. Adult living donor liver transplantation across ABO-incompatibility. Medicine (Baltimore), 2015, 94(42): e1796.
19.	Egawa H, Teramukai S, Haga H, et al. Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: a Japanese multicenter study. Am J Transplant, 2014, 14(1): 102-114.
20.	Ikegami T, Yoshizumi T, Soejima Y, et al. Feasible usage of ABO incompatible grafts in living donor liver transplantation. Hepatobiliary Surg Nutr, 2016, 5(2): 91-97.
21.	Yoon YI, Song GW, Lee SG, et al. Outcome of ABO-incompatible adult living-donor liver transplantation for patients with hepatocellular carcinoma. J Hepatol, 2018, 68(6): 1153-1162.
22.	Kim SH, Lee EC, Shim JR, et al. A simplified protocol using rituximab and immunoglobulin for ABO-incompatible low-titre living donor liver transplantation. Liver Int, 2018, 38(5): 932-939.
23.	Lee J, Lee JG, Lee JJ, et al. Results of ABO-incompatible liver transplantation using a simplified protocol at a single institution. Transplant Proc, 2015, 47(3): 723-726.
24.	Yadav DK, Hua YF, Bai X, et al. ABO-incompatible adult living donor liver transplantation in the era of rituximab: A systematic review and meta-analysis. Gastroenterol Res Pract, 2019, 2019: 8589402.
25.	Mysore KR, Himes RW, Rana A, et al. ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes. Pediatr Transplant, 2018, 22(7): e13263.

1. Farges O, Kalil AN, Samuel D, et al. The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients. Transplantation, 1995, 59(8): 1124-1133.
2. Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers. Lancet, 1990, 336(8714): 519-523.
3. Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier. Transplantation, 1994, 58(5): 543-547.
4. Urbani L, Mazzoni A, Bianco I, et al. The role of immunomodulation in ABO-incompatible adult liver transplant recipients. J Clin Apher, 2008, 23(2): 55-62.
5. Ikegami T, Taketomi A, Soejima Y, et al. Rituximab, IVIG, and plasma exchange without graft local infusion treatment: a new protocol in ABO incompatible living donor liver transplantation. Transplantation, 2009, 88(3): 303-307.
6. Egawa H, Teramukai S, Haga H, et al. Present status of ABO-incompatible living donor liver transplantation in Japan. Hepatology, 2008, 47(1): 143-152.
7. Kim JD, Choi DL, Kim SG, et al. Single-center experience of ABO-incompatible living-donor liver transplantation with a new simplified intravenous immunoglobulin protocol: A propensity score-matching analysis. Transplant Proc, 2016, 48(4): 1134-1138.
8. 金磊, 殷浩, 傅宏, 等. 跨血型肝移植26例经验. 中华肝胆外科杂志, 2014, 20(10): 705-709.
9. Kazatchkine MD, Kaveri SV. Immunomodulation of autoimmune and inflammatory diseases with intravenous immune globulin. N Engl J Med, 2001, 345(10): 747-755.
10. Watanabe J, Scornik JC. IVIG and HLA antibodies. Evidence for inhibition of complement activation but not for anti-idiotypic activity. Am J Transplant, 2005, 5(11): 2786-2790.
11. Basta M, Van Goor F, Luccioli S, et al. F(ab)′ 2-mediated neutralization of C3a and C5a anaphylatoxins: a novel effector function of immunoglobulins. Nat Med, 2003, 9(4): 431-438.
12. Jordan SC, Vo A, Tyan D, et al. Desensitization therapy with intravenous gammaglobulin (IVIG): applications in solid organ transplantation. Trans Am Clin Climatol Assoc, 2006, 117: 199-211.
13. Samuelsson A, Towers TL, Ravetch JV. Anti-inflammatory activity of IVIG mediated through the inhibitory Fc receptor. Science, 2001, 291(5503): 484-486.
14. Kim JD, Choi DL, Han YS. Fourteen successful consecutive cases of ABO-incompatible living donor liver transplantation: new simplified intravenous immunoglobulin protocol without local infusion therapy. Transplant Proc, 2014, 46(3): 754-757.
15. Gelfand EW. Critical decisions in selecting an intravenous immunoglobulin product. J Infus Nurs, 2005, 28(6): 366-374.
16. Welsh KJ, Bai Y. Therapeutic plasma exchange as a therapeutic modality for the treatment of IVIG complications. J Clin Apher, 2015, 30(6): 371-374.
17. Shen T, Lin BY, Jia JJ, et al. A modified protocol with rituximab and intravenous immunoglobulin in emergent ABO-incompatible liver transplantation for acute liver failure. Hepatobiliary Pancreat Dis Int, 2014, 13(4): 395-401.
18. Lee CF, Cheng CH, Wang YC, et al. Adult living donor liver transplantation across ABO-incompatibility. Medicine (Baltimore), 2015, 94(42): e1796.
19. Egawa H, Teramukai S, Haga H, et al. Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: a Japanese multicenter study. Am J Transplant, 2014, 14(1): 102-114.
20. Ikegami T, Yoshizumi T, Soejima Y, et al. Feasible usage of ABO incompatible grafts in living donor liver transplantation. Hepatobiliary Surg Nutr, 2016, 5(2): 91-97.
21. Yoon YI, Song GW, Lee SG, et al. Outcome of ABO-incompatible adult living-donor liver transplantation for patients with hepatocellular carcinoma. J Hepatol, 2018, 68(6): 1153-1162.
22. Kim SH, Lee EC, Shim JR, et al. A simplified protocol using rituximab and immunoglobulin for ABO-incompatible low-titre living donor liver transplantation. Liver Int, 2018, 38(5): 932-939.
23. Lee J, Lee JG, Lee JJ, et al. Results of ABO-incompatible liver transplantation using a simplified protocol at a single institution. Transplant Proc, 2015, 47(3): 723-726.
24. Yadav DK, Hua YF, Bai X, et al. ABO-incompatible adult living donor liver transplantation in the era of rituximab: A systematic review and meta-analysis. Gastroenterol Res Pract, 2019, 2019: 8589402.
25. Mysore KR, Himes RW, Rana A, et al. ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes. Pediatr Transplant, 2018, 22(7): e13263.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical effect of perioperative intravenous immunoglobulin on ABO incompatible liver transplantation

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