FIGURE 2.

Four other cases with anti-donor A/B IgG titer ≥2048 in the era of rituximab. All recipients received rituximab 2–3 wk before transplantation, followed by 2–4 sessions of PEX. A significant reduction in anti-donor A/B IgG titers was observed in all the patients before transplantation (A–D). Only case 4 (D) showed a slight increase in the anti-B IgG titer post-transplant and received additional rituximab on post-transplant day 6. None of the patients have developed antibody-mediated rejection (AMR), and all achieved specific immune tolerance to anti-donor A/B antigens. Additional details are provided in Table 1. *The green arrow indicates 1 session of PEX using 1.5-fold estimated plasma volume of fresh-frozen plasma (FFP). Three green arrows indicate that PEX was performed daily for 3 consecutive days until the day before living-donor liver transplantation (LDLT). DSA, donor-specific antibody; LT, liver transplantation; PEX, plasma exchange; Ritux., rituximab.