Perioperative Desensitization in Immunologically High-Risk Living Donor Liver Transplantation: A Multicenter Comparative Study
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Perioperative desensitization strategies for living donor liver transplantation (LDLT) recipients with immunologically high risk remain inconsistently defined across centers. This multicenter retrospective cohort study compared outcomes in 105 ABO-compatible LDLT recipients with donor-specific antibody (DSA) mean fluorescence intensity (MFI) ≥ 5,000 across two centers with different desensitization strategies (rituximab/plasmapheresis vs. none) between 2015 and 2023, with propensity score matching performed within immunologic risk strata. Desensitized recipients demonstrated lower crude rejection rates (25.5% vs. 36.0%) and significantly improved biliary complication–free survival (p = 0.023), with benefits most pronounced in high-risk recipients after propensity score matching, while overall survival and graft failure–free survival did not differ significantly between groups. These findings suggest that preoperative desensitization may attenuate early immune-mediated graft injury, particularly in high-risk LDLT recipients with elevated DSA burden, though survival benefits remain to be established.
Source: Research Square
Institutions: Seoul National University Hospital, Severance Hospital
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7225386764