Feasibility of ABO-incompatible adult living donor liver transplantation for acute-on-chronic liver failure

To the Editor:In Korea, the annual number of deceased donors for organ transplantation per million people is still less than10. Thus, approximately 40% of patients with acute liver failure or acute-on-chronic liver failure undergo living donor liver transplantation (LDLT).[1] Although the use of ABO...

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Bibliographic Details
Published in:Hepatobiliary & pancreatic diseases international 2017-12, Vol.16 (6), p.662-664
Main Authors: Kim, Seok-Hwan, Song, Gi-Won, Hwang, Shin, Ahn, Chul-Soo, Moon, Deok-Bog, Ha, Tae-Yong, Lee, Sung-Gyu
Format: Article
Language:English
Subjects:
ABO Blood-Group System - immunology
acute-on-chronic
Acute-On-Chronic Liver Failure - diagnosis
Acute-On-Chronic Liver Failure - surgery
Adult
Blood Group Incompatibility - diagnosis
Blood Group Incompatibility - immunology
failure
Female
Graft Rejection - immunology
Graft Rejection - prevention & control
Graft Survival
Histocompatibility
Humans
Immunosuppressive Agents - administration & dosage
liver
Liver Transplantation - adverse effects
Liver Transplantation - methods
Living Donors
Male
Middle Aged
Plasma Exchange
Rituximab - administration & dosage
TPE
ABOi
Treatment Outcome
Young Adult
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Summary:To the Editor:In Korea, the annual number of deceased donors for organ transplantation per million people is still less than10. Thus, approximately 40% of patients with acute liver failure or acute-on-chronic liver failure undergo living donor liver transplantation (LDLT).[1] Although the use of ABO-incompatible (ABOi) living donors is an attractive option, ABOi LDLT has very restricted applications for expanding the donor pool.[2] The main reason for its limited application is the considerable time required for desensitization using the anti-CD20 monoclonal antibody,rituximab (RIT), and total plasma exchange (TPE).For the effective suppression of B-cell activity, most protocols usually require the administration of RIT for 2-3weeks prior to LDLT.[2] Although the impact of TPE on the pharmacokinetics of RIT is not well known in the LDLT setting, very early initiation of TPE immediately after RIT infusion significantly reduces the plasma concentration of RIT.Therefore, a certain waiting interval between RIT administration and TPE might be a more rational approach for preventing the post-LDLT rebound rise in the B-cell count and isoagglutinin titer, which may render ABOi LDLT unsuitable for patients requiring urgent LDLT.
ISSN:1499-3872
DOI:10.1016/S1499-3872(17)60060-2