Adult living-donor liver transplantation with ABO-incompatible grafts.
BACKGROUND
Liver transplantation using ABO-incompatible grafts is rarely performed because the reported outcome is poorer than with compatible grafts. We report our positive experience with adult-to-adult living-donor liver transplant (LDLT) using ABO-incompatible grafts.


METHODS
The immunosuppressive protocol consisted of plasmapheresis/intravenous immunoglobulin infusion before LDLT followed by thymoglobulin induction and splenectomy, maintenance with tacrolimus/cyclosporine (FK/CSA), mycophenolate mofetil, and a rapid steroid taper. Plasmapheresis was planned for up to 3 months after LDLT aiming at maintaining the anti-ABO titers level below 1:16. Liver biopsies were routinely stained for humoral rejection with complement 4d (C4d) and for biliary damage with cytokeratin 7.


RESULTS
Between January 2003 and September 2004, five patients, mean age 59 years, received an ABO-incompatible LDLT. Patient and graft survival was 80% at mean follow-up of 43 months (range, 34-54) for the four surviving patients. One patient died 4 months after LDLT. Humoral rejection occurred in one patient whereas acute cellular rejection was diagnosed in four patients.


CONCLUSIONS
ABO-incompatible LDLT can be performed with patient and graft survival similar to compatible LDLT. Minimization of immunosuppression is possible, and chronic biliary damage is not the norm. Better tools than complement 4d staining must be researched to diagnose the features of immunologic damage to the graft. If these results will be confirmed in a greater number of patients, ABO-incompatible LDLT may be proposed when ABO-compatible donors are not available or when the ABO-incompatible donor is the better candidate.
Testa
Giuliano
G
Department of Surgery, University of Chicago Hospitals, Chicago, IL 60637, USA. gtesta@surgery.bsd.uchicago.edu
Vidanovic
Vladimir
V
Chejfec
Gregorio
G
Gangemi
Antonio
A
Iqpal
Ronak
R
Porubsky
Marian
M
Pham
Thuy
T
Benedetti
Enrico
E
D000017:ABO Blood-Group System; D000368:Aged; D001706:Biopsy; D001787:Blood Group Incompatibility; D015935:Complement C4b / Q000032:analysis; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D019520:Living Donors; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D010956:Plasmapheresis; D011183:Postoperative Complications / Q000145:classification / Q000473:pathology; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors
D000017:ABO Blood-Group System; D010446:Peptide Fragments; D015935:Complement C4b; C032261:complement C4d