title: Successful adult ABO incompatible living donor liver transplantation: experience with double infusion through the hepatic artery and portal vein.
abstract: OBJECTIVE
  Multiple immunosuppressants, plasma exchanges (PEs), splenectomy, and/] or local infusion therapy (either hepatic artery (HA) or portal vein (PV) infusion) are needed in patients undergoing ABO-incompatible living donor liver transplantation (LDLT). Local infusion therapy is commonly undertaken using the single route, and double-infusion therapy has scarcely been investigated. Herein, we describe our experience with five ABO-incompatible LDLT patients who received double-infusion therapy via both the HA and PV.
  
  
  METHODS
  Five patients (age 43-67 years, with HBV, HBV+HCC, HCV+HCC, PBC, cryptogenic) underwent ABO-incompatible LDLT. Following multiple PEs, LDLT with splenectomy was performed. Triple-immunosuppressant and double-infusion therapy, namely, methylprednisolone and PGE1 via the HA and gabexate mesilate via the PV were employed.
  
  
  RESULTS
  All five patients achieved accommodation (22-66 months). One patient experienced transient AMR, and recovered after PE and intraarterial steroid infusion. Four of the five patients experienced PV mural thrombi near the PV catheter and recovered with pharmacological treatment.
  
  
  CONCLUSIONS
  Thus, double-infusion therapy could also be useful for ABO-incompatible LDLT under control against PV mural thrombi.
authors.affiliation: Department of Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Wada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Masahito
authors.initials: M
authors.lastname: Tanemura
authors.forename: Koji
authors.initials: K
authors.lastname: Umeshita
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility; D005260:Female; D006084:Graft Rejection; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System