title: Apheresis therapy for living-donor liver transplantation: experience for apheresis use for living-donor liver transplantation at Kyoto University.
abstract: Liver transplantation is a fundamental treatment for patients with end-stage hepatic failure. In order to perform living-donor liver transplantations under safer conditions, apheresis plays a major role in Japan due to the prevalence of living-donor liver transplantation wherein later retransplantation is difficult. In our department, the roles of apheresis in liver transplantation are as follows: as bridge therapy to liver transplantation (n = 45); as a supplement to the graft liver until the recovery of hepatic function (n = 77); as treatment for multiple organ failure including posttransplantation renal failure (n = 15); and as a means with which to reduce antibody titers for antibodies such as anti-A or anti-B in persons with ABO blood type = incompatible liver transplantation (n = 23). In our department, we have performed 822 liver transplantations at present. Of those cases, 183 were selected wherein apheresis was performed around the time of the operation. In all cases, transplantation with sufficient apheresis was performed before the surgical operation, however, 22 patients (48.9%) died after undergoing surgery. Among the patients who underwent the postoperative apheresis, those in the nonsurvivor group had lower grafted liver weights compared to those of the survivor group. The kidney was the organ that most frequently failed due to postoperative complications. In cases of ABO blood type-incompatible liver transplantations, patients with high preoperative anti-A/B IgM antibody titers sustained bile duct complications, patients with high preoperative anti-IgG antibody titers sustained hepatic necrosis, and patients with high postoperative anti-A/B IgM and anti-IgG antibody titers sustained hepatic necrosis most frequently.
authors.affiliation: Department of Transplantation and Immunology, Division of Artificial Kidneys, Kyoto University Graduate School of Medicine, Kyoto, Japan. KKozaki@Kuhp.Kyoto-u.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Kozaki
authors.forename: Mureo
authors.initials: M
authors.lastname: Kasahara
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Oike
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogura
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaihara
authors.forename: Atushi
authors.initials: A
authors.lastname: Fukatsu
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D001781:Blood Component Removal; D001787:Blood Group Incompatibility / Q000628:therapy; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D016031:Liver Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000628:therapy; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy
chemical_list: D007518:Isoantibodies