Open AccessEarly plasmapheresis and rituximab for acute humoral rejection after ABO-compatible liver transplantation
Author(s) -
Nassim Kamar,
Laurence Lavayssière,
Fabrice Muscari,
Janick Sèlves,
Céline GuilbeauFrugier,
I. Cardeau,
Laure Esposito,
Olivier Cointault,
Marie Béatrice Nogier,
Jean Marie Péron,
Philippe Otal,
Marylise Fort,
Lionel Rostaing
Publication year - 2009
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.15.3426
Subject(s) - plasmapheresis , rituximab , medicine , liver transplantation , transplantation , liver biopsy , gastroenterology , immunology , abo blood group system , biopsy , surgery , antibody
Acute humoral rejection (AHR) is uncommon after ABO-compatible liver transplantation. Herein, we report two cases of AHR treated with plasmapheresis and rituximab in two ABO-compatible liver-transplant patients with preformed anti-human leukocyte antigen donor-specific antibodies. Patient 1 experienced a biopsy-proven AHR at day 10 post-transplant. She was treated by steroid pulses, and OKT3. Because of persisting signs of biopsy-proven AHR at day 26, she was treated by plasmapheresis and rituximab. Liver enzyme levels did not improve, and she died on day 41. Patient 2 experienced a biopsy-proven AHR on day 10 post-transplant. She was treated by steroid pulses, plasmapheresis, and rituximab. Liver enzymes returned to within normal range 18 d after diagnosis. Liver biopsies, at 3 and 9 mo post-transplant, showed complete resolution of AHR. We conclude that plasmapheresis should be started as soon as AHR is diagnosed, and be associated with a B-cell depleting agent. Rituximab may be considered as a first-line therapy.