title: Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia.
abstract: BACKGROUND
  The problem of ABO-incompatible liver transplantation still remains unsolved in older children. In this article, we report on our experience of 6 successful ABO-incompatible liver transplantations in patients with biliary atresia.
  
  
  METHODS
  Six patients (ABO incompatibility type A-->O:1 case, B-->O:2 cases, A-->B:3 cases) were enrolled in this study; 3 patients were aged approximately 1 year and the other 3 ranged in age from 9 to 24 years at the time of transplantation. Each patient received perioperative plasma exchange, until the anti-donor blood-type antibody titers became less than 1:16, and also systemic multidrug immunosuppressive therapy (cyclophosphamide, prednisolone, and tacrolimus). We applied the protocol of intraportal infusion therapy (local administration of prostaglandin E(1), steroid, and gabexate mesilate via a portal vein catheter), splenectomy, and rituximab administration for the older group.
  
  
  RESULTS
  Both the patient and graft survival rates remain at 100%, with the follow-up period of the patients ranging from 12 and 123 months. Acute cellular rejection occurred in 2 cases, and both were steroid sensitive. There was no incidence of humoral rejection. Although all cases developed viral infection, all recovered uneventfully with the administration of antiviral agents.
  
  
  CONCLUSIONS
  ABO-incompatible liver transplantation can be performed with a low risk of humoral rejection or late biliary complications using this combined antirejection strategy, even in older children.
authors.affiliation: Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Yamada
authors.forename: Ken
authors.initials: K
authors.lastname: Hoshino
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Morikawa
authors.forename: Jun
authors.initials: J
authors.lastname: Okamura
authors.forename: Ryo
authors.initials: R
authors.lastname: Hotta
authors.forename: Koji
authors.initials: K
authors.lastname: Komori
authors.forename: Shioko
authors.initials: S
authors.lastname: Nakao
authors.forename: Hideaki
authors.initials: H
authors.lastname: Obara
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Kawachi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuchimoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Tanabe
authors.forename: Motohide
authors.initials: M
authors.lastname: Shimazu
authors.forename: Masaki
authors.initials: M
authors.lastname: Kitajima
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000527:Alprostadil / Q000008:administration & dosage; D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002985:Clinical Protocols; D016670:Gabexate / Q000008:administration & dosage; D005938:Glucocorticoids / Q000008:administration & dosage; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006401:Hematologic Agents / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007262:Infusions, Intravenous; D016031:Liver Transplantation / Q000276:immunology*; D010951:Plasma Exchange; D011169:Portal Vein; D013156:Splenectomy; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System; D005938:Glucocorticoids; D006401:Hematologic Agents; D007166:Immunosuppressive Agents; D016670:Gabexate; D000527:Alprostadil