Perioperative Management for Liver Transplantation with DSA Positive Patients

Abstract

Background: Liver transplantation is an accepted treatment for end-stage liver disease. Despite improvements of the surgical techniques, organ preservation methods, and immunosuppressive therapy, antibody mediated rejection is still big problem. It has been reported that the existence of donor-specific antibodies (DSA) is correlated with rejection and with an increased risk of early mortality. We described our treatment and prognosis about the patient who has undergone liver transplantation with DSA. Methods: 16 patients among 87 patients of recipient who has undergone liver transplantation in our department from September 2011 to December 2018. In each patient, the type of DSA and the MFI were measured before liver transplantation. A high DSA titer was defined as a normalized, trimmed MFI value ≥10000. Patients received the standard immunosuppressive protocol for liver transplantation, including steroids, tacrolimus, and mycophenolate mofetil, with addition of rituximab more than two weeks before transplantation and took medication such as tacrolimus and mycophenolate mofetil one week before the transplantation. During operation, each patient underwent splenectomy. Results: 7 patients have high titer DSA, and each patient has a desensitization method that described before. Only one patient was dead because of other disease. 9 patients are still arrived without severe rejection. Conclusion: If the patients who has DSA was undergone right desensitization methods, we can get good survival rate.