title: Successful ABO-incompatible pediatric liver transplantation utilizing standard immunosuppression with selective postoperative plasmapheresis.
abstract: 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.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA 30322, USA. thomas.heffron@choa.org
authors.forename: Thomas
authors.initials: T
authors.lastname: Heffron
authors.forename: David
authors.initials: D
authors.lastname: Welch
authors.forename: Todd
authors.initials: T
authors.lastname: Pillen
authors.forename: Massimo
authors.initials: M
authors.lastname: Asolati
authors.forename: Gregory
authors.initials: G
authors.lastname: Smallwood
authors.forename: Phil
authors.initials: P
authors.lastname: Hagedorn
authors.forename: Chang
authors.initials: C
authors.lastname: Nam
authors.forename: Alexander
authors.initials: A
authors.lastname: Duncan
authors.forename: Mark
authors.initials: M
authors.lastname: Guy
authors.forename: Enrique
authors.initials: E
authors.lastname: Martinez
authors.forename: James
authors.initials: J
authors.lastname: Spivey
authors.forename: Patricia
authors.initials: P
authors.lastname: Douglas
authors.forename: Carlos
authors.initials: C
authors.lastname: Fasola
authors.forename: Jill
authors.initials: J
authors.lastname: De Paolo
authors.forename: John
authors.initials: J
authors.lastname: Rodriguez
authors.forename: Rene
authors.initials: R
authors.lastname: Romero
mesh_terms: 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
chemical_list: D000017:ABO Blood-Group System