Liver transplantation across ABO blood groups in children

• Published in: Transplantation proceedings 2003-09, Vol.35 (6), p.2273-2274
• Main Authors: Szymczak, M, Kalicinski, P, Kaminski, A, Ismail, H, Drewniak, T, Nachulewicz, P, Broniszczak, D
• Format: Article
• Language: English
• Subjects: ABO Blood-Group System - immunology; Biological and medical sciences; Child; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hepatic Encephalopathy - surgery; Humans; Immunosuppression - methods; Liver Failure - surgery; Liver Transplantation - immunology; Liver Transplantation - mortality; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2003.08.002

Late results after ABOI LTx are inferior to ABO compatible organs. We report seven patients who received LTx across ABO group for emergency indications. The blood type combinations were: A to O in three, B to O in two, and B to A in two. Episodes of acute and chronic rejection, immunosuppression, and biochemical and functional tests after transplantation as well as patient and graft survival were compared between ABOI group and patients with compatible ABO group transplanted due to FLF (group I) or in an elective setting (group II). Four children are alive. Two children died of sepsis and CNS damage or MOF, and one patient died during transplantation because of cardiac failure. All recipients of ABOI grafts received immunosuppression with cyclosporine or tacrolimus and steroids. MMF was added in two subjects, and induction with antilymphocyte globulins used in five patients. An acute rejection episode was diagnosed in two recipients between 7 and 11 days after LTx. All four living patients with ABOI grafts are doing well with follow-up time between 11 months and 5 years. In one patient PTLD occurred at 1 year after ABOI LTx but was cured by discontinuation of immunosuppression and administration of rituximab. Graft survival in the ABOI group was 57.1% versus 71% in group I and 73% in group II. Respective patients survival was 57.1% 71%, and 82.0% respectively. In conclusion, in urgent cases ABOI transplantation is justified in pediatric patients when compatible grafts are not available.