title: Successful ABO-incompatible liver transplantation using A2 donors.
abstract: BACKGROUND
  The longer waiting time for a liver graft among patients with blood group O makes it necessary to expand the donor pool for these patients. We herein have reported our experience with ABO-incompatible liver transplantation using A(2) donors to blood group O recipients.
  
  
  METHODS
  Between 1996 to 2005, 10 adult blood group O recipients received 10 A(2) cadaveric grafts. Mean recipient age was 52 +/- 7.7 years (mean +/- SD). The initial immunosuppression was induction with antithymocyte globulin (n = 2), interleukin-2-receptor antagonists (n = 3), or anti-CD20 antibody (rituximab, n = 1), followed by a tacrolimus-based protocol. No preoperative plasmapheresis, immunoadsorption, or splenectomies were performed.
  
  
  RESULTS
  Patient and graft survival was 10/10 and 8/10, respectively, at 8.5 months median follow-up (range 10 days to 109 months). Two patients were retransplanted because of bacterial arteritis (n = 1) and portal vein thrombosis (n = 1). The six acute rejections, which occurred in four patients, were all reversed by steroids or increased tacrolimus dosages. The pretransplant anti-A titers against A(1) red blood cells were 1:128 (NaCl technique) and 1:8 to 1024 (IAT technique). The maximum postoperative titers were 1:64 to 4000 (NaCl) and 1:256 to 32000 (IAT).
  
  
  CONCLUSIONS
  The favorable outcome of A(2) to O grafting, with a patient survival of 10/10 and graft survival of 8/10, makes it possible to consider this blood group combination also in nonurgent situations. There was no hyperacute rejection or increased rate of rejections. Anti-A/B titer changes seem to not play a significant role in the monitoring of A(2) to O liver transplantation.
authors.affiliation: Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. u.skogsberg@glocalnet.net
authors.forename: U
authors.initials: U
authors.lastname: Skogsberg
authors.forename: M E
authors.initials: ME
authors.lastname: Breimer
authors.forename: S
authors.initials: S
authors.lastname: Friman
authors.forename: L
authors.initials: L
authors.lastname: Mjörnstedt
authors.forename: J
authors.initials: J
authors.lastname: Mölne
authors.forename: M
authors.initials: M
authors.lastname: Olausson
authors.forename: L
authors.initials: L
authors.lastname: Rydberg
authors.forename: C T
authors.initials: CT
authors.lastname: Svalander
authors.forename: L
authors.initials: L
authors.lastname: Bäckman
mesh_terms: D000017:ABO Blood-Group System; D001787:Blood Group Incompatibility; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000017:ABO Blood-Group System