Efficacy and safety of intravenous immunoglobulin therapy for antibody-mediated rejection after liver transplantation

DOI
  • ITO Takashi
    Department of Surgery, Graduate School of Medicine, Kyoto University
  • SHIMIZU Seiichi
    Organ Transplantation Center, National Center for Child Health and Development
  • SAWADA Yuu
    Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine
  • SANADA Yukihiro
    Department of Surgery, Jichi Medical University
  • YASUI Kazuya
    Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine
  • OHIRA Masahiro
    Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
  • HASEGAWA Yasushi
    Department of Surgery, Keio University School of Medicine
  • NAKANUMA Shinichi
    Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University
  • KURAMITSU Kaori
    Kobe University Graduate School of Medicine, Hepato-biliary and Pancreatic Surgery
  • SOYAMA Akihiko
    Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
  • SHIMAMURA Tsuyoshi
    Division of Organ Transplantation, Hokkaido University Hospital
  • KODERA Yoshito
    Department of Surgery, Tokyo Women’s Medical University
  • TANEMURA Akihiro
    Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University
  • OGAWA Kohei
    Department of HBP and Breast Surgery, Ehime University Graduate School of Medicine
  • YOSHIZUMI Tomoharu
    Department of Surgery and Science, Kyushu University Hospital
  • SHIMADA Keita
    Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences
  • NAKAGAWA Ken
    Department of Urology, Ichikawa General Hospital Tokyo Dental College
  • EGAWA Hiroto
    Hamamatsu Rosai Hospital

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Other Title
  • 肝移植後の抗体関連拒絶反応に対する免疫グロブリン静注（intravenous immunoglobulin；IVIg）療法の有効性と安全性

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<p>【Introduction】 Therapeutic strategies for antibody mediated rejection (AMR) after liver transplantation are gradually being established; however, the efficacy of intravenous immunoglobulin (IVIg) therapy as a treatment for AMR after liver transplantation is not clear. The purpose of this multicenter, retrospective, observational study was to clarify the actual status of AMR treatment using IVIg in Japan, and the efficacy and safety of IVIg therapy.</p><p>【Methods】 Sixty-one liver transplant recipients diagnosed with AMR and treated with IVIg between April 2001 and March 2022 were analyzed. Sixty-one patients in the secondary survey who were treated with IVIG were analyzed for efficacy and safety in a retrospective study.</p><p>【Results】 Acute AMR was observed in 86.0% of adult cases, and 94.4% of pediatric cases. Acute T cell-mediated rejection (TCMR) was also concomitant with AMR in 48.8% of adult patients and 22.2% of pediatric patients. When AMR develops after liver transplantation, IVIg + PE and IVIg + steroid pulse therapy was the most common treatment in adult patients (27.9%). In pediatric cases, IVIg therapy alone was the most commonly used, at 38.9%. Patient survival and graft survival rates at 6 months after AMR treatment including IVIg in adult patients were 69.8% and 69.8%, respectively and were 94.4% and 88.9% in pediatric patients, respectively.</p><p>Serious adverse events, including those with unknown causal relationship, were observed in 7.0% of adult cases and 5.6% of pediatric cases.</p><p>【Conclusion】 AMR treatment including IVIg is safe and has sufficient therapeutic effect and may be one of the effective treatment modalities for the development of AMR after liver transplantation.</p>

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