Living Donor Liver Transplantation In A Highly Allo-Sensitized Recipient: Confusing Influence Of Rituximab On The Lymphocytotoxicity Crossmatch Test. A Case Report

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.