ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor

Background & Aims ABO-incompatible liver transplantation is usually contraindicated because of the risk of antibody-mediated humoral rejection of the graft. We describe 22 successful cases of patients who had living donor liver transplantation (LDLT) from ABO-incompatible donors. Methods The imm...

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Bibliographic Details
Published in:Journal of hepatology 2013-12, Vol.59 (6), p.1215-1222
Main Authors: Kim, Jong Man, Kwon, Choon Hyuck David, Joh, Jae-Won, Kang, Eun-Suk, Park, Jae Berm, Lee, Joon Hyeok, Kim, Sung Joo, Paik, Seung Woon, Lee, Suk-Koo, Kim, Dae Won
Format: Article
Language:English
Subjects:
ABO Blood-Group System - immunology
ABO-incompatible
Adult
Blood Group Incompatibility
Female
Gastroenterology and Hepatology
Humans
Immunoglobulin G - blood
Immunoglobulin M - blood
Isoagglutinin titer
Liver Transplantation
Living donor liver transplantation
Living Donors
Male
MELD score
Middle Aged
Plasmapheresis
Rituximab
Severity of Illness Index
Systemic infusion
Therapeutic plasma exchange
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Summary:Background & Aims ABO-incompatible liver transplantation is usually contraindicated because of the risk of antibody-mediated humoral rejection of the graft. We describe 22 successful cases of patients who had living donor liver transplantation (LDLT) from ABO-incompatible donors. Methods The immunosuppressive protocol consisted of rituximab and plasmapheresis prior to LDLT. Plasmapheresis was planned for up to 2 weeks after LDLT aiming at maintaining levels of anti-ABO titers below 1:32. Results The median age of recipients was 54 years and the median MELD score was 13. The initial range of isoagglutinin IgM and IgG titers were 1:8–1:1024 and 1:2–1:1024, respectively. Preoperative isoagglutinin IgM and IgG titers were achieved less than or equal to 1:8 by performing therapeutic plasma exchange (TPE). While the median number of TPE was 4 (range, 2–18) in all patients, it was 4 (range, 2–8) in the initial low titer group (
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2013.07.035