Successful ABO-incompatible pediatric liver transplantation utilizing standard immunosuppression with selective postoperative plasmapheresis.
Transplanting blood group A, B, or O (ABO)-incompatible (ABO-I) liver grafts has resulted in lower patient and graft survival with an increased incidence of vascular and biliary complications and rejection. We report that, without modification of our standard immunosuppression protocol, crossing blood groups is an acceptable option for children requiring liver transplantation. In our study, ABO-I liver grafts -- regardless of recipient age -- have comparable long-term survival (mean follow-up of 3.25 yr) with ABO-compatible grafts without any difference in rejection, vascular or biliary complications. From January 1, 1999 to October 1, 2005, we studied 138 liver transplants in 121 children: 16 (13.2%) received an ABO incompatible liver allograft. One-year actuarial patient survival for ABO-matched grafts vs. ABO-I grafts was 93.0% and 100%, respectively, whereas graft survival was 83.4% and 92.3%. Additionally, 6 of 16 (37.5%) ABO-I transplanted children had 8 rejection episodes, whereas 47 patients (44.8%) had 121 rejection episodes in the ABO-compatible group. There were no vascular complications and 2 biliary strictures in the ABO-I group. Plasmapheresis was not used for pretransplantation desensitization and was only required in 1 posttransplantation recipient. No child was splenectomized. Six of the 16 children were older than 13 yr of age, suggesting the possibility of successfully expanding this technique to an older population. In conclusion, our outcomes may support the concept of using ABO-I grafts in a more elective setting associated with split and living donor liver transplants.
Heffron
Thomas
T
Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA. thomas.heffron@choa.org
Welch
David
D
Pillen
Todd
T
Asolati
Massimo
M
Smallwood
Gregory
G
Hagedorn
Phil
P
Nam
Chang
C
Duncan
Alexander
A
Guy
Mark
M
Martinez
Enrique
E
Spivey
James
J
Douglas
Patricia
P
Fasola
Carlos
C
De Paolo
Jill
J
Rodriguez
John
J
Romero
Rene
R
D000017:ABO Blood-Group System; D000293:Adolescent; D001787:Blood Group Incompatibility; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D010956:Plasmapheresis
D000017:ABO Blood-Group System