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Results of ABO-incompatible liver transplantation using a simplified protocol at a single institution

 J. Lee  ;  J.G. Lee  ;  J.J. Lee  ;  M.S. Kim  ;  M.K. Ju  ;  G.H. Choi  ;  J.S. Choi  ;  S.I. Kim  ;  D.J. Joo 
 TRANSPLANTATION PROCEEDINGS, Vol.47(3) : 723-726, 2015 
Journal Title
Issue Date
ABO Blood-Group System/immunology* ; Adolescent ; Adult ; Blood Group Incompatibility/immunology ; Blood Group Incompatibility/therapy* ; Child ; Child, Preschool ; Combined Modality Therapy ; End Stage Liver Disease/immunology ; End Stage Liver Disease/surgery* ; Female ; Graft Rejection/immunology ; Graft Rejection/prevention & control* ; Humans ; Immunoglobulins, Intravenous/therapeutic use ; Immunosuppressive Agents/therapeutic use ; Infant ; Infant, Newborn ; Infusions, Intravenous ; Liver Transplantation/methods* ; Living Donors ; Male ; Middle Aged ; Plasma Exchange ; Rituximab/therapeutic use ; Splenectomy ; Transplantation Conditioning/methods* ; Treatment Outcome ; Young Adult
BACKGROUND: Because of the development of various desensitization strategies, ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has become a feasible option for patients with end-stage liver disease. However, there has been no united desensitization protocol for ABOi LDLT. We analyzed the outcomes after establishment of simplified protocol without splenectomy, intravenous immunoglobulin, and local infusion therapy.
METHODS: We analyzed 19 ABOi LDLT cases that had been performed between January 2012 and December 2013, without splenectomy and local infusion. We used a single dose of rituximab (375 mg/m(2)) 10 days before transplantation and several series of plasma exchange according to the recipients' iso-agglutinin titer-to-target titer ratio of 1:32.
RESULTS: Nineteen recipients received ABOi LTs from living donors. The mean initial immunoglobulin (Ig) M and IgG anti-ABO titers were 76.63 ± 78.81 (range, 8∼256) and 162.53 ± 464.1 (0∼2048). We performed preoperative plasma exchange to 16 recipients (mean number of sessions, 3.58; range, 1-10). After surgery, 9 patients received plasma exchange (mean, 1.84; range 1∼14). One death occurred as the result of pneumonia (5.3%). There were 4 cases of acute rejections (21.1%), and all of them were treated successfully with steroid pulse or thymoglobulin. Antibody-mediated rejection and graft failure did not occur. Six cases of postoperative complications (31.6%) occurred, including 3 cases of infections. There were 2 cases of biliary anastomotic stricture (10.5%) and 1 case of portal vein stenosis (5.3%).
CONCLUSIONS: ABOi LDLT with the use of simplified protocol can be safely performed without increased risk of antibody-mediated rejection and other complications.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Myoung Soo(김명수) ORCID logo https://orcid.org/0000-0002-8975-8381
Kim, Soon Il(김순일) ORCID logo https://orcid.org/0000-0002-0783-7538
Lee, Jae Geun(이재근) ORCID logo https://orcid.org/0000-0002-6722-0257
Lee, Ju Han(이주한)
Joo, Dong Jin(주동진) ORCID logo https://orcid.org/0000-0001-8405-1531
Joo, Man Ki(주만기) ORCID logo https://orcid.org/0000-0002-4112-7003
Choi, Gi Hong(최기홍) ORCID logo https://orcid.org/0000-0002-1593-3773
Choi, Jin Sub(최진섭)
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