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Kim H, Yi NJ, Song EY, Lee K, Lee KW, Lee HW, Ahn HY, Yoon KC, Hong SK, Suh KS. Preformed donor-specific antibodies do not affect the 1-year allograft survival in living donor liver transplantation. Clin Transplant 2018; 32:e13244. [DOI: 10.1111/ctr.13244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Hyeyoung Kim
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Department of Surgery; Seoul Metropolitan Government - Seoul National University Boramae Medical Center; Seoul Korea
| | - Nam-Joon Yi
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Eun Young Song
- Department of Laboratory Medicine; Seoul National University College of Medicine; Seoul Korea
| | - Kyoungbun Lee
- Department of Pathology; Seoul National University College of Medicine; Seoul Korea
| | - Kwang-Woong Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Hae Won Lee
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
- Department of Surgery; Seoul Metropolitan Government - Seoul National University Boramae Medical Center; Seoul Korea
| | - Hye Young Ahn
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kyung Chul Yoon
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Suk Kyun Hong
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
| | - Kyung-Suk Suh
- Department of Surgery; Seoul National University College of Medicine; Seoul Korea
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Yi NJ, Park MS, Song EY, Ahn HY, Byun J, Kim H, Hong SK, Yoon K, Kim HS, Ahn SW, Lee HW, Choi Y, Lee KW, Suh KS, Park MH. Pretransplantation fetal-maternal microchimerism in pediatric liver transplantation from mother. World J Gastroenterol 2017; 23:8017-8026. [PMID: 29259377 PMCID: PMC5725296 DOI: 10.3748/wjg.v23.i45.8017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the rates of pretransplantation fetal-maternal microchimerism (MC) and its effect on rejection in children receiving maternal liver grafts.
METHODS DNA or blood samples before liver transplantation (LT) were available in 45 pediatric patients and their mothers. The presence of pretransplantation MC to non-inherited maternal antigens (NIMAs) (NIMA-MC) in the peripheral blood was tested using nested PCR-single-strand conformation polymorphism analysis for the human leukocyte antigen (HLA)-DRB1 alleles. NIMA-MC was successfully evaluated in 26 of the 45 children. Among these 45 pediatric LT recipients, 23 children (51.1%) received transplants from maternal donors and the other 22 from non-maternal donors.
RESULTS Among these 26 children, pretransplantation NIMA-MC was detected in 23.1% (n = 6), 6.1 (range, 0.8-14) years after birth. Among the children with a maternal donor, the rate of biopsy-proven cellular rejection (BPCR) was 0% in patients with NIMA-MC positivity (0/3) and those with HLA-DR identity with the mother (0/4), but it was 50% in those with NIMA-MC negativity (5/10). Patients with NIMA-MC positivity or HLA-DR identity with the mother showed significantly lower BPCR rate compared with NIMA-MC-negative patients (0% vs 50%, P = 0.04). NIMA-MC-positive patients tended to show lower BPCR rate compared with NIMA-MC-negative patients (P = 0.23).
CONCLUSION The presence of pretransplantation NIMA-MC or HLA-DR identity with the mother could be associated with BPCR-free survival in pediatric recipients of LT from maternal donors.
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Affiliation(s)
- Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Min-Su Park
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
- Department of Surgery, Kyung Hee University School of Medicine, Seoul 02447, South Korea
| | - Eun Young Song
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Hye Young Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Jeik Byun
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Kyungchul Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Hyo-Sin Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Sung-Woo Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Myoung Hee Park
- Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul 03080, South Korea
- Korea Organ Donation Agency Laboratory, Seoul 06052, South Korea
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Living Donor Liver Transplantation in a Highly Allo-Sensitized Recipient: Confusing Influence of Rituximab on the Lymphocytotoxicity Crossmatch Test. A Case Report. Int Surg 2017. [DOI: 10.9738/intsurg-d-16-00246.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: We report a successful living donor liver transplantation (LDLT) from donor (husband) to highly allo-sensitized recipient (wife) against donor-adopting sufficient preoperative preparation. Methods: A 47-year-old woman with primary biliary cirrhosis was referred to our hospital as a potential candidate of LDLT. Her husband was willing to donate his hemiliver. As the lymphocytotoxicity crossmatch (LCT-XM) test based on a complement-dependent cytotoxicity and flow panel reactive antibody (PRA) test revealed that the patient had strong donor-specific anti-HLA antibody, the patient received rituximab twice for preoperative desensitization. A total of 5 rounds of plasmapheresis were also performed. Results: Nevertheless, the LCT-XM test 9 days after the administration of rituximab did not turn to negative while flow PRA test was almost negative. Suspecting that residual rituximab in the recipient's serum might interfere with the LCT-XM test because of its potential ability to activate the complement, we retried the test after absorbing rituximab from the serum with immunomagnetic bead. Conclusion: The result: The LCT-XM test turned to negative, suggesting that the desensitization therapy was adequate. A left liver graft was transplanted as planned, and the postoperative course was uneventful. The patient is doing well 12 months after transplantation.
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Nugroho A, Kim OK, Lee KW, Song S, Kim H, Hong SK, Yoon KC, Kim HS, Choi Y, Lee HW, Yi NJ, Suh KS. Evaluation of donor workups and exclusions in a single-center experience of living donor liver transplantation. Liver Transpl 2017; 23:614-624. [PMID: 28294533 DOI: 10.1002/lt.24762] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/27/2017] [Indexed: 02/07/2023]
Abstract
The process of evaluating potential donors in liver transplantation is important to ensure donor safety and provide optimal recipient outcomes. However, there has been no report about donor exclusion rates and reasons for such exclusion in Korea. In this study, we aimed to elucidate the outcomes of potential living liver donor evaluation in a major living donor liver transplantation center. From July 2011 to June 2015, prospectively collected data of 726 potential donors for 588 matched recipients were subsequently evaluated. Among 726 potential donors, 374 potential donors (51.5%) finally reached donation; 352 potential donors (48.5%) were excluded for various reasons. Donor reasons were 29.8%, including medical problems, withdrawal of consent, graft volume issues, and identification of a better suitable donor. Recipient reasons were 20.7%, including recipient death or recovery, allocation to deceased donor, and progressions of hepatocellular carcinoma. A total of 38 (5.2%) potential donors had a fatty liver. Among them, 15 (39.5%) potential donors tried short-term weight reduction and eventually were able to donate. In conclusion, the main reasons for donor exclusion were medical problems and withdrawal of consent. Therefore, thorough medical screening and careful examination for donor voluntarism are important in the donor evaluation process. Liver Transplantation 23 614-624 2017 AASLD.
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Affiliation(s)
- Adianto Nugroho
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ok-Kyung Kim
- Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Sanghee Song
- Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Hyeyoung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Suk Kyun Hong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung Chul Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyo-Sin Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.,Organ Transplant Center, Seoul National University Hospital, Seoul, South Korea
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Kornberg A. Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation. World J Hepatol 2015; 7:1494-1508. [PMID: 26085909 PMCID: PMC4462688 DOI: 10.4254/wjh.v7.i11.1494] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/19/2015] [Accepted: 05/08/2015] [Indexed: 02/06/2023] Open
Abstract
Shortage of appropriate donor grafts is the foremost current problem in organ transplantation. As a logical consequence, waiting times have extended and pretransplant mortality rates were significantly increasing. The implementation of a priority-based liver allocation system using the model of end-stage liver disease (MELD) score helped to reduce waiting list mortality in liver transplantation (LT). However, due to an escalating organ scarcity, pre-LT MELD scores have significantly increased and liver recipients became more complex in recent years. This has finally led to posttransplant decreasing survival rates, attributed mainly to elevated rates of infectious and immunologic complications. To meet this challenging development, an increasing number of extended criteria donor grafts are currently accepted, which may, however, aggravate the patients’ infectious and immunologic risk profiles. The administration of intravenous immunoglobulins (IVIg) is an established treatment in patients with immune deficiencies and other antibody-mediated diseases. In addition, IVIg was shown to be useful in treatment of several disorders caused by deterioration of the cellular immune system. It proved to be effective in preventing hyperacute rejection in highly sensitized kidney and heart transplants. In the liver transplant setting, the administration of specific Ig against hepatitis B virus is current standard in post-LT antiviral prophylaxis. The mechanisms of action of IVIg are complex and not fully understood. However, there is increasing experimental and clinical evidence that IVIg has an immuno-balancing impact by a combination of immuno-supporting and immuno-suppressive properties. It may be suggested that, especially in the context of a worsening organ shortage with all resulting clinical implications, liver transplant patients should benefit from immuno-regulatory capabilities of IVIg. In this review, perspectives of immune modulation by IVIg and impact on outcome in liver transplant patients are described.
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