title: Cascade plasmapheresis (CP) as a preconditioning regime in ABO-incompatible live related donor liver transplants (ABOi-LDLT).
abstract: BACKGROUND
  ABO-incompatible live donor liver transplant (ABOi-LDLT) is being widely done to bridge the gap of demand and supply of organs. Different desensitization regimes are being used to reduce titer of blood group antibodies for successful transplant and accommodation of graft. The authors used cascade plasmapheresis (CP) to bring down titer of naturally occurring blood group antibody to 16 or lower.
  
  
  METHODS
  Four recipients of ABOi-LDLT were of blood groups O, O, B, and B while donors were of blood groups B, A, AB, and AB, respectively. Desensitization protocol included immunosuppressive drugs and plasmapheresis. CP consisted of separating patient's plasma as the first step and passing it through pore size based filter column as the second step. The first step was performed using disposable kit (PL1, Fresenius Kabi, Germany) with minor modification on apheresis equipment COM.TEC (Fresenius Kabi, Germany). Pore size based filter column used was 2A column (Evaflux, Kawasumi Laboratories, Japan). Blood group antibody titer (immunoglobulin G (IgG)) was done by column agglutination technology (Ortho-Clinical Diagnostics).
  
  
  RESULTS
  Cases 1, 2, 3, and 4 with pre-CP titer of 1,024, 512, 32, and 64 required four, three, one, and one CP procedures, respectively. No signs of antibody-mediated rejection were exhibited on histopathological evaluation by any of the patients. Successful organ engraftment occurred as documented by post-operative liver function tests and liver biopsy.
  
  
  CONCLUSIONS
  Cascade plasmapheresis offers a cost-effective and efficient way to decrease blood group antibody titer and helps in successful transplant.
authors.affiliation: Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon 122001, India.
authors.forename: Aseem Kumar
authors.initials: AK
authors.lastname: Tiwari
authors.affiliation: Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon 122001, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Pandey
authors.affiliation: Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon 122001, India.
authors.forename: Geet
authors.initials: G
authors.lastname: Aggarwal
authors.affiliation: Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon 122001, India.
authors.forename: Ravi C
authors.initials: RC
authors.lastname: Dara
authors.affiliation: Department of Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon 122001, India.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rawat
authors.affiliation: Laboratory Services and Transfusion Medicine, Medanta-The Medicity, Sector-38, Gurgaon 122001, India.
authors.forename: Vimarsh
authors.initials: V
authors.lastname: Raina
authors.affiliation: Department of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Sector-38, Gurgaon 122001, India.
authors.forename: Arvinder Singh
authors.initials: AS
authors.lastname: Soin
keywords: ABO-compatible transplant; ABO-incompatible live related donor liver transplants (ABOi-LDLT); ABO-incompatible transplant; Cascade plasmapheresis; Plasmapheresis; Titer; Transplant