ArticleSurgery today2026
Impact of rituximab-based desensitization on T cell-mediated rejection in ABO-incompatible liver transplantation.
Article in Surgery today, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRituximab-based desensitization has enabled successful ABO-incompatible (ABO-I) liver transplantation (LT) by preventing antibody-mediated rejection (AMR). However, its effect on T cell-mediated rejection (TCMR) remains unclear. We conducted a comparative analysis between ABO-compatible (ABO-C) and ABO-I LT to evaluate the effects of rituximab-based desensitization on TCMR.
methodsWe retrospectively analyzed 45 LT recipients (32 ABO-C and 13 ABO-I recipients) treated with basiliximab-based immunosuppression. The ABO-I group additionally received rituximab-based desensitization therapy. The lymphocyte subpopulations, rejection, adverse events, and outcomes were assessed.
resultsAMR was not observed in either group. TCMR occurred within 4 weeks post-transplantation in 0% of ABO-C cases and 38.5% of ABO-I cases (P = 0.0011). In ABO-C, a significant increase in B cells (CD19+) was observed within the first week, whereas in ABO-I, B cells remained depleted and an increase in T cells (CD3+) was observed. In all the ABO-I cases, TCMR occurred under suppressed CD25 + conditions. Adverse events were comparable between the groups. The 1-year survival rates for the ABO-C and ABO-I groups were 96.9% and 100%, respectively.
conclusionRituximab-based desensitization in ABO-I LT is associated with an increased incidence of early TCMR. Rituximab-induced B-cell depletion may promote T-cell activation through an IL-2-independent pathway, potentially contributing to increased TCMR.
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