Work

Increasing the liver donation pool: Eculizumab desensitization for ABO-incompatible living donor liver transplantation – A case series

Year: 2025

Type: article

Abstract: INTRODUCTION: ABO-incompatible living donor liver transplantation (ABO-I LDLT) is limited by the risk of antibody-mediated rejection (AMR) from preformed anti-A/B antibodies. Conventional desensitization with therapeutic plasma exchange (TPE) and rituximab (RTX) has procedural and logistical drawbacks. METHODS: We conducted a retrospective analysis of patients who underwent ABO-I LDLT at our center between January 2022 and December 2023. All were managed with eculizumab (ECU) at a dose of 900 mg IV on preoperative day - 1 and again within two weeks, without preoperative TPE or RTX. RESULTS: Median recipient age was 49.5 years (MELD 14). All achieved prompt graft function. No biopsy-proven AMR was identified in the patients in whom biopsy was performed. Complement activity normalized by POD 30 in all cases. At a mean follow-up of 17 months, three patients had stable graft function; one died at one year from a cerebrovascular event unrelated to rejection. CONCLUSION: ECU-based complement inhibition may offer a simplified, potentially AMR-reducing approach in ABO-I LDLT; these findings are preliminary and hypothesis-generating, requiring validation in larger studies.

Source: Human Immunology

DOI: 10.1016/j.humimm.2025.111637