Long-term follow-up ABO-incompatible adult living donor liver transplantation in cirrhotic patients.
ABO-incompatible liver transplantation is usually contraindicated. The presence in the recipient of preformed anti-A/B antibodies located on endothelial cells raises the risk of antibody-mediated humoral rejection of the graft. We describe four successful cases of steroid withdrawal in adult patients who had living-donor liver transplantation from ABO-incompatible donors. Antirejection therapy included multiple perioperative plasmapheresis, splenectomy, and a triple immunosuppressive regimen with tacrolimus, methylprednisolone (MPSL), and cyclophosphamide or mycophenolate mofetil (MMF). The maintenance dose of immunosuppression did not differ from that of ABO-identical cases. After transplantation, intrahepatic arterial infusion therapy with prostaglandin E1 (PG E1) was used. As a result, all four patients were able to achieve long-term graft survival without steroid use. They all have good liver function and are leading normal lifestyles. Our experience with these four patients suggests the feasibility of controlling humoral rejection and other complications in adult ABO-incompatible living donor liver transplantations with intrahepatic arterial infusion of PGE1, splenectomy, and plasmapheresis with a regular base of immunosuppression protocol to prevent antibody-mediated humoral rejection.
Matsuno
Naoto
N
Department of Surgery, Hachioji Medical Center, Tokyo Medical University, Hachioji, Tokyo, Japan. mtn@tokyo-med.ac.jp
Nakamura
Yuki
Y
Mejit
Abudushukur
A
Hama
Koichiro
K
Iwamoto
Hitoshi
H
Konno
Osamu
O
Jojima
Yoshimaro
Y
Akashi
Isao
I
Iwahori
Tohru
T
Ashizawa
Tatsuhito
T
Nagao
Takeshi
T
D000017:ABO Blood-Group System / Q000009:adverse effects* / Q000276:immunology; D000328:Adult; D000527:Alprostadil / Q000627:therapeutic use; D000075202:Contraindications; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D008103:Liver Cirrhosis / Q000628:therapy*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D013156:Splenectomy; D013256:Steroids / Q000008:administration & dosage; D017741:Survivors
D000017:ABO Blood-Group System; D013256:Steroids; D000527:Alprostadil