Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation.
BACKGROUND
ABO-incompatible liver transplantation is associated with an extremely complicated postoperative course, especially when the recipients are adults.


METHODS
Two adult patients underwent living-donor liver transplantation from ABO-incompatible donors. The antirejection therapy included multiple perioperative plasmapheresis, splenectomy, systemic triple immunosuppressive regimen with tacrolimus, methylprednisolone, and cyclophophamide, or azathioprine. In addition to these conventional approaches, we performed intraportal infusion therapy after transplantation with methylprednisolone, prostaglandin E1, and gabexate mesilate.


RESULTS
With our protocol, antidonor blood group antibody titers in both cases remained low without any evidence of rejection or vascular complications throughout the postoperative course. Biliary complications were transient and resolved completely. The patients have now survived 30 and 12 months posttransplantation and have regained normal life activity with good liver function.


CONCLUSIONS
Our experience has shown the feasibility of controlling rejection and other complications in adult ABO-incompatible liver transplantation under intraportal infusion therapy.
Tanabe
Minoru
M
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Shimazu
Motohide
M
Wakabayashi
Go
G
Hoshino
Ken
K
Kawachi
Shigeyuki
S
Kadomura
Tomohisa
T
Seki
Hiroaki
H
Morikawa
Yasuhide
Y
Kitajima
Masaki
M
D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged
D000017:ABO Blood-Group System