ABO-incompatible living donor liver transplantation without graft local infusion and splenectomy.
BACKGROUND
Graft local infusion and splenectomy in ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) are associated with high rates of operative complications.


METHODS
Consecutive ABO-I LDLT patients treated at the National Cancer Centre between January 2012 and February 2013 were identified. The protocol for ABO-I LDLT at the study centre included the administration of rituximab (300 mg/m(2)) at 2 weeks preoperatively, followed by plasma exchanges (target isoagglutinin titre: ≤ 1:8), basiliximab (20 mg on the day of surgery and on postoperative day 4), and i.v. immunoglobulin (0.8 g/kg on postoperative days 1 and 4) without graft local infusion or splenectomy.


RESULTS
Fifteen patients (11 men and four women) who underwent transplantation for liver cirrhosis (n = 3) or hepatocellular carcinoma (n = 12) were identified. These included 13 patients with hepatitis B virus infection, one with hepatitis C virus infection and one with alcoholic cirrhosis. The mean age, mean Model for End-stage Liver Disease (MELD) score and mean graft-to-recipient weight ratio (GRWR) of these patients was 51.8 years, 11.5 and 0.84, respectively. The median isoagglutinin titre before plasma exchange was 1:32 (range: 1:4 to 1:256). There were no hyperacute or antibody-mediated rejections. No bacterial or fungal infections were observed. Complications included herpes zoster viral infection in one patient, postoperative bleeding in one patient and extrahepatic biliary stricture in three patients.


CONCLUSIONS
This simplified ABO-I LDLT protocol showed good graft outcomes without immunologic failure or serious infections.
Centre for Liver Cancer, National Cancer Centre, Goyang-si, South Korea.
Seung Duk
SD
Lee
Seong Hoon
SH
Kim
Sun-Young
SY
Kong
Young-Kyu
YK
Kim
Soon-Ae
SA
Lee
Sang-Jae
SJ
Park
D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000077552:Basiliximab; D001787:Blood Group Incompatibility / Q000276:immunology*; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D005260:Female; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D011237:Predictive Value of Tests; D011993:Recombinant Fusion Proteins / Q000627:therapeutic use; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000069283:Rituximab; D000077552:Basiliximab