title: ABO-incompatible liver transplantation in acute liver failure: a single Portuguese center study.
abstract: BACKGROUND
  ABO-incompatible liver transplantation (ABOi LT) is considered to be a rescue option in emergency transplantation. Herein, we have reported our experience with ABOi LT including long-term survival and major complications in these situations.
  
  
  METHODS
  ABOi LT was performed in cases of severe hepatic failure with imminent death. The standard immunosuppression consisted of basiliximab, corticosteroids, tacrolimus, and mycophenolate mofetil. Pretransplantation patients with anti-ABO titers above 16 underwent plasmapheresis. If the titer was above 128, intravenous immunoglobulin (IVIG) was added at the end of plasmapheresis. The therapeutic approach was based on the clinical situation, hepatic function, and titer evolution. A rapid increase in titer required five consecutive plasmapheresis sessions followed by administration of IVIG, and at the end of the fifth session, rituximab.
  
  
  RESULTS
  From January 2009 to July 2012, 10 patients, including 4 men and 6 women of mean age 47.8 years (range, 29 to 64 years), underwent ABOi LT. At a mean follow-up of 19.6 months (range, 2 days to 39 months), 5 patients are alive including 4 with their original grafts. One patient was retransplanted at 9 months. Major complications were infections, which were responsible for 3 deaths due to multiorgan septic failure (2 during the first month); rejection episodes (4 biopsy-proven of humoral rejections in 3 patients and 1 cellular rejection) and biliary.
  
  
  CONCLUSIONS
  The use of ABOi LT as a life-saving procedure is justifiable in emergencies when no other donor is available. With careful recipient selection close monitoring of hemagglutinins and specific immunosuppression we have obtained acceptable outcomes.
authors.affiliation: Department of Nephrology, Centro Hospitalar de Lisboa Central, Hospital Curry Cabral, Lisbon, Portugal. marcomendes82@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Mendes
authors.forename: A C
authors.initials: AC
authors.lastname: Ferreira
authors.forename: A
authors.initials: A
authors.lastname: Ferreira
authors.forename: F
authors.initials: F
authors.lastname: Remédio
authors.forename: I
authors.initials: I
authors.lastname: Aires
authors.forename: A
authors.initials: A
authors.lastname: Cordeiro
authors.forename: A
authors.initials: A
authors.lastname: Mascarenhas
authors.forename: A
authors.initials: A
authors.lastname: Martins
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.forename: H
authors.initials: H
authors.lastname: Gloria
authors.forename: R
authors.initials: R
authors.lastname: Perdigoto
authors.forename: J
authors.initials: J
authors.lastname: Veloso
authors.forename: P
authors.initials: P
authors.lastname: Ferreira
authors.forename: J
authors.initials: J
authors.lastname: Oliveira
authors.forename: M
authors.initials: M
authors.lastname: Silva
authors.forename: E
authors.initials: E
authors.lastname: Barroso
authors.forename: F
authors.initials: F
authors.lastname: Nolasco
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011174:Portugal; D000069283:Rituximab
chemical_list: D000017:ABO Blood-Group System; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab