Successful case of adult ABO-incompatible liver transplantation: beneficial effects of intrahepatic artery infusion therapy: a case report.
BACKGROUND
In Japan ABO-incompatible liver transplantation has been done on >100 occasions up to 2003. However, <30% are cases involving adults. The difficultly of ABO-incompatible liver transplantation is associated with the high frequency of humoral rejection and local disseminated intravascular coagulation (DIC), leading to many postoperative complications. We report a successful case of adult ABO-incompatible liver transplantation with the use of an intrahepatic artery infusion.


METHODS
A 36-year-old man with Wilson disease, underwent living donor liver transplantation from an ABO-incompatible donor. The immunosuppressive therapy included multiple perioperative plasmaphereses, splenectomy, and treatment with tacrolimus, methylprednisolone, and cyclophosphamide. The dose and blood level of tacrolimus were the same as in ABO-compatible cases. In addition to these therapies, we administered an intrahepatic arterial infusion with prostaglandin (PG) E1 alone.


RESULTS
After perioperative plasmapheresis and cyclophosphamide, antidonor blood group antibody titers remained undiluted and without vascular complications throughout the postoperative course, but there was a tendency for bleeding that continued for 10 days after transplantation. On postoperative day 10, a reexploration was performed for intraabdominal bleeding. During another operation on postoperative day 59 a biloma was found and drained. The patient has now survived for 120 days after transplantation with normal liver function.


CONCLUSIONS
Beneficial effect of intrahepatic artery infusion with PGE1 seems to be useful in adult ABO-incompatible liver transplantation.
Nakamura
Y
Y
Fifth Department of Surgery, Tokyo Medical University, Tokyo, Japan. yn10@tokyo-med.ac.jp
Matsuno
N
N
Iwamoto
H
H
Yokoyama
T
T
Kuzuoka
K
K
Kihara
Y
Y
Taira
S
S
Sagara
T
T
Jojima
Y
Y
Konno
O
O
Tashiro
J
J
Akashi
I
I
Hama
K
K
Narumi
K
K
Iwahori
T
T
Uchiyama
M
M
Tanaka
K
K
Nagao
T
T
D000017:ABO Blood-Group System; D000328:Adult; D001787:Blood Group Incompatibility; D004359:Drug Therapy, Combination; D006499:Hepatic Artery; D006527:Hepatolenticular Degeneration / Q000097:blood / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007261:Infusions, Intra-Arterial; D007430:Intraoperative Care; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology / Q000379:methods*; D019520:Living Donors; D008297:Male; D010956:Plasmapheresis; D013156:Splenectomy; D016896:Treatment Outcome
D000017:ABO Blood-Group System; D007166:Immunosuppressive Agents