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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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| Published in: | Journal of hepatology 2013-12, Vol.59 (6), p.1215-1222 |
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| creator | 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 |
| description | 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 ( |
| doi_str_mv | 10.1016/j.jhep.2013.07.035 |
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| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1459974398</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0168827813005503</els_id><sourcerecordid>1459974398</sourcerecordid><originalsourceid>FETCH-LOGICAL-c477t-421717f780e946e7ba30e9052d8940317118eb7ef4cd956875f4ba5364589c123</originalsourceid><addsrcrecordid>eNp9kcGO1SAUhonRONfRF3BhunTTeii00MSYzEx0xmSSWahrQumpl9pCBTpm3l6aO7pw4QoI3_8HvkPIawoVBdq-m6rpiGtVA2UViApY84QcaAtQQsvpU3LIkCxlLeQZeRHjBAAMOv6cnNWsqyUHeSB4cXlXWmf8supk-xmL2d5b970YvPNhP2AoUtAurrN2KTPeFTYWcbNJ77h1xZ5El2Lxy6aj31Kxdy46mSMOp56X5Nmo54ivHtdz8u3Tx69XN-Xt3fXnq4vb0nAhUslrKqgYhQTseIui1yzvoKkH2XFg-ZJK7AWO3Axd00rRjLzXDWt5IztDa3ZO3p561-B_bhiTWmw0OOeno9-iorzpOsFZJzNan1ATfIwBR7UGu-jwoCioXa-a1K5X7XoVCJX15tCbx_6tX3D4G_njMwPvTwDmX95bDCqa7MbgYAOapAZv_9__4Z-4ma2zRs8_8AHj5Lfgsj9FVawVqC_7gPf5UgbQNMDYbzehoFI</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1459974398</pqid></control><display><type>article</type><title>ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor</title><source>ScienceDirect Journals</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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 (<1:256) and 8 (range, 6–18) in the high titer group (⩾1:256). There were no statistically significant differences for liver function tests in the first 2 weeks after transplantation between the groups having high MELD score (⩾20) vs. low MELD score (<20), local graft infusion vs. systemic infusion, or high initial isoagglutinin titer (⩾1:256) vs. low initial isoagglutinin titer (<1:256). Patient and graft survival was 100% and there was no acute humoral rejection in recipients at a mean follow-up of 10 months (range, 3–21). Conclusions ABO-incompatible LDLT can be safely performed when rituximab and TPE are used, and may be proposed when ABO-compatible donors are not available.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2013.07.035</identifier><identifier>PMID: 23928408</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>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</subject><ispartof>Journal of hepatology, 2013-12, Vol.59 (6), p.1215-1222</ispartof><rights>2013</rights><rights>Crown Copyright © 2013. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c477t-421717f780e946e7ba30e9052d8940317118eb7ef4cd956875f4ba5364589c123</citedby><cites>FETCH-LOGICAL-c477t-421717f780e946e7ba30e9052d8940317118eb7ef4cd956875f4ba5364589c123</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23928408$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Jong Man</creatorcontrib><creatorcontrib>Kwon, Choon Hyuck David</creatorcontrib><creatorcontrib>Joh, Jae-Won</creatorcontrib><creatorcontrib>Kang, Eun-Suk</creatorcontrib><creatorcontrib>Park, Jae Berm</creatorcontrib><creatorcontrib>Lee, Joon Hyeok</creatorcontrib><creatorcontrib>Kim, Sung Joo</creatorcontrib><creatorcontrib>Paik, Seung Woon</creatorcontrib><creatorcontrib>Lee, Suk-Koo</creatorcontrib><creatorcontrib>Kim, Dae Won</creatorcontrib><title>ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>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 (<1:256) and 8 (range, 6–18) in the high titer group (⩾1:256). There were no statistically significant differences for liver function tests in the first 2 weeks after transplantation between the groups having high MELD score (⩾20) vs. low MELD score (<20), local graft infusion vs. systemic infusion, or high initial isoagglutinin titer (⩾1:256) vs. low initial isoagglutinin titer (<1:256). Patient and graft survival was 100% and there was no acute humoral rejection in recipients at a mean follow-up of 10 months (range, 3–21). Conclusions ABO-incompatible LDLT can be safely performed when rituximab and TPE are used, and may be proposed when ABO-compatible donors are not available.</description><subject>ABO Blood-Group System - immunology</subject><subject>ABO-incompatible</subject><subject>Adult</subject><subject>Blood Group Incompatibility</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Humans</subject><subject>Immunoglobulin G - blood</subject><subject>Immunoglobulin M - blood</subject><subject>Isoagglutinin titer</subject><subject>Liver Transplantation</subject><subject>Living donor liver transplantation</subject><subject>Living Donors</subject><subject>Male</subject><subject>MELD score</subject><subject>Middle Aged</subject><subject>Plasmapheresis</subject><subject>Rituximab</subject><subject>Severity of Illness Index</subject><subject>Systemic infusion</subject><subject>Therapeutic plasma exchange</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp9kcGO1SAUhonRONfRF3BhunTTeii00MSYzEx0xmSSWahrQumpl9pCBTpm3l6aO7pw4QoI3_8HvkPIawoVBdq-m6rpiGtVA2UViApY84QcaAtQQsvpU3LIkCxlLeQZeRHjBAAMOv6cnNWsqyUHeSB4cXlXWmf8supk-xmL2d5b970YvPNhP2AoUtAurrN2KTPeFTYWcbNJ77h1xZ5El2Lxy6aj31Kxdy46mSMOp56X5Nmo54ivHtdz8u3Tx69XN-Xt3fXnq4vb0nAhUslrKqgYhQTseIui1yzvoKkH2XFg-ZJK7AWO3Axd00rRjLzXDWt5IztDa3ZO3p561-B_bhiTWmw0OOeno9-iorzpOsFZJzNan1ATfIwBR7UGu-jwoCioXa-a1K5X7XoVCJX15tCbx_6tX3D4G_njMwPvTwDmX95bDCqa7MbgYAOapAZv_9__4Z-4ma2zRs8_8AHj5Lfgsj9FVawVqC_7gPf5UgbQNMDYbzehoFI</recordid><startdate>20131201</startdate><enddate>20131201</enddate><creator>Kim, Jong Man</creator><creator>Kwon, Choon Hyuck David</creator><creator>Joh, Jae-Won</creator><creator>Kang, Eun-Suk</creator><creator>Park, Jae Berm</creator><creator>Lee, Joon Hyeok</creator><creator>Kim, Sung Joo</creator><creator>Paik, Seung Woon</creator><creator>Lee, Suk-Koo</creator><creator>Kim, Dae Won</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20131201</creationdate><title>ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c477t-421717f780e946e7ba30e9052d8940317118eb7ef4cd956875f4ba5364589c123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>ABO Blood-Group System - immunology</topic><topic>ABO-incompatible</topic><topic>Adult</topic><topic>Blood Group Incompatibility</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Humans</topic><topic>Immunoglobulin G - blood</topic><topic>Immunoglobulin M - blood</topic><topic>Isoagglutinin titer</topic><topic>Liver Transplantation</topic><topic>Living donor liver transplantation</topic><topic>Living Donors</topic><topic>Male</topic><topic>MELD score</topic><topic>Middle Aged</topic><topic>Plasmapheresis</topic><topic>Rituximab</topic><topic>Severity of Illness Index</topic><topic>Systemic infusion</topic><topic>Therapeutic plasma exchange</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Jong Man</creatorcontrib><creatorcontrib>Kwon, Choon Hyuck David</creatorcontrib><creatorcontrib>Joh, Jae-Won</creatorcontrib><creatorcontrib>Kang, Eun-Suk</creatorcontrib><creatorcontrib>Park, Jae Berm</creatorcontrib><creatorcontrib>Lee, Joon Hyeok</creatorcontrib><creatorcontrib>Kim, Sung Joo</creatorcontrib><creatorcontrib>Paik, Seung Woon</creatorcontrib><creatorcontrib>Lee, Suk-Koo</creatorcontrib><creatorcontrib>Kim, Dae Won</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Jong Man</au><au>Kwon, Choon Hyuck David</au><au>Joh, Jae-Won</au><au>Kang, Eun-Suk</au><au>Park, Jae Berm</au><au>Lee, Joon Hyeok</au><au>Kim, Sung Joo</au><au>Paik, Seung Woon</au><au>Lee, Suk-Koo</au><au>Kim, Dae Won</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor</atitle><jtitle>Journal of hepatology</jtitle><addtitle>J Hepatol</addtitle><date>2013-12-01</date><risdate>2013</risdate><volume>59</volume><issue>6</issue><spage>1215</spage><epage>1222</epage><pages>1215-1222</pages><issn>0168-8278</issn><eissn>1600-0641</eissn><abstract>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 (<1:256) and 8 (range, 6–18) in the high titer group (⩾1:256). There were no statistically significant differences for liver function tests in the first 2 weeks after transplantation between the groups having high MELD score (⩾20) vs. low MELD score (<20), local graft infusion vs. systemic infusion, or high initial isoagglutinin titer (⩾1:256) vs. low initial isoagglutinin titer (<1:256). Patient and graft survival was 100% and there was no acute humoral rejection in recipients at a mean follow-up of 10 months (range, 3–21). Conclusions ABO-incompatible LDLT can be safely performed when rituximab and TPE are used, and may be proposed when ABO-compatible donors are not available.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>23928408</pmid><doi>10.1016/j.jhep.2013.07.035</doi><tpages>8</tpages></addata></record> |
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| ispartof | Journal of hepatology, 2013-12, Vol.59 (6), p.1215-1222 |
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| 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 |
| title | ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor |
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