Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia.
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.
Yamada
Yohei
Y
Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan.
Hoshino
Ken
K
Morikawa
Yasuhide
Y
Okamura
Jun
J
Hotta
Ryo
R
Komori
Koji
K
Nakao
Shioko
S
Obara
Hideaki
H
Kawachi
Shigeyuki
S
Fuchimoto
Yasushi
Y
Tanabe
Minoru
M
Shimazu
Motohide
M
Kitajima
Masaki
M
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
D000017:ABO Blood-Group System; D005938:Glucocorticoids; D006401:Hematologic Agents; D007166:Immunosuppressive Agents; D016670:Gabexate; D000527:Alprostadil