title: End-stage liver cirrhosis with severe autoimmune hemolytic anemia, treated by blood type-incompatible living donor liver transplantation: a case report.
abstract: We present a case of successful living donor liver transplantation (LDLT) for liver cirrhosis caused by hepatitis B virus with severe autoimmune hemolytic anemia (AIHA) using an ABO-incompatible (ABOi) graft. The patient was a 47-year-old woman who had a history of ruptured esophageal varices, accumulation of intractable ascites, frequent hepatic encephalopathy and severe anemia, with a hemoglobin value of approximately 3 g/dL due to AIHA. We treated the patient by LDLT using an ABOi liver graft. The treatment strategy included anti-CD20 antibody, plasma exchange and transfusion before LDLT. The patient's anemia improved after surgery; she required only 2 units of irradiated red blood cell concentrates-leukocytes reduced. The patient was discharged from the hospital on postoperative day 35. Two years after surgery, the patient still shows normal hepatic and hematological findings. The immunomodulation protocol for ABOi LDLT was effective not only to avoid humoral reactions associated with ABOi LDLT, but also those associated with AIHA.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. sanefuji@surg2.med.kyushu-u.ac.jp
authors.forename: K
authors.initials: K
authors.lastname: Sanefuji
authors.forename: T
authors.initials: T
authors.lastname: Ikegami
authors.forename: S
authors.initials: S
authors.lastname: Nagata
authors.forename: K
authors.initials: K
authors.lastname: Sugimachi
authors.forename: T
authors.initials: T
authors.lastname: Gion
authors.forename: H
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Y
authors.initials: Y
authors.lastname: Soejima
authors.forename: A
authors.initials: A
authors.lastname: Taketomi
authors.forename: K
authors.initials: K
authors.lastname: Shirabe
authors.forename: Y
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008875:Middle Aged; D014057:Tomography, X-Ray Computed