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. 2016 Apr;5(2):91-7.
doi: 10.3978/j.issn.2304-3881.2015.06.02.

Feasible usage of ABO incompatible grafts in living donor liver transplantation

Toru Ikegami  1 , Tomoharu Yoshizumi  1 , Yuji Soejima  1 , Hideaki Uchiyama  1 , Ken Shirabe  1 , Yoshihiko Maehara  1
Affiliations

Feasible usage of ABO incompatible grafts in living donor liver transplantation

Toru Ikegami et al. Hepatobiliary Surg Nutr. 2016 Apr.

Abstract

Background: The use of ABO incompatible (ABOi) graft in living donor liver transplantation (LDLT) has not been an established procedure worldwide.

Methods: Four hundred and eight adult LDLTs, using ABOi (n=19) and non-ABOi (n=389) grafts, were performed as a single center experience.

Results: In ABOi-LDLT group (n=19), median isoagglutinin titer before plasma exchange (PE) at LDLT and after LDLT (max) was ×256, ×32 and ×32, respectively. Rituximab was given at 21.8±6.1 days before LDLT and PE was performed 3.7±1.6 times. Although ABOi-LDLTs had increased rate of splenectomy (89.4% vs. 44.7%, P<0.001) and lower portal venous pressure (PVP) at the end of surgery (13.8±1.1 vs. 16.9±0.2 mmHg, P=0.003), other operative factors including graft ischemic time, operative time and blood loss were not different between the groups. Although ABOi-LDLTs had increased incidence of cytomegalovirus infection (52.6% vs. 22.9%, P=0.007), other post-transplant complications including bacterial sepsis and acute rejection were not different between the groups. The 5-year graft survival rate was 87.9% in ABOi-LDLTs and 80.3% in non-ABOi-LDLTs (P=0.373).

Conclusions: ABOi-LDLT could be safely performed, especially under rituximab-based protocol.

Keywords: ABO incompatible (ABOi); living donor liver transplantation (LDLT); rituximab.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The current desensitization protocol for ABO incompatible living donor liver transplantation at Kyushu University Hospital. HD-IVIG, high-dose intravenous immunoglobulin.
Figure 2
Figure 2
The changes of isoagglutinin titer, before at and after (maximum value within the first month) living donor liver transplantation. Two patients received plasma exchanges after transplantation. LDLT, living donor liver transplantation; ABOi, ABO incompatible.
Figure 3
Figure 3
The cumulative graft survival data. ABOi, ABO incompatible; LDLT, living donor liver transplantation.
See this image and copyright information in PMC

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