title: Results of ABO-incompatible liver transplantation using a simplified protocol at a single institution.
abstract: BACKGROUND
  Because of the development of various desensitization strategies, ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has become a feasible option for patients with end-stage liver disease. However, there has been no united desensitization protocol for ABOi LDLT. We analyzed the outcomes after establishment of simplified protocol without splenectomy, intravenous immunoglobulin, and local infusion therapy.
  
  
  METHODS
  We analyzed 19 ABOi LDLT cases that had been performed between January 2012 and December 2013, without splenectomy and local infusion. We used a single dose of rituximab (375 mg/m(2)) 10 days before transplantation and several series of plasma exchange according to the recipients' iso-agglutinin titer-to-target titer ratio of 1:32.
  
  
  RESULTS
  Nineteen recipients received ABOi LTs from living donors. The mean initial immunoglobulin (Ig) M and IgG anti-ABO titers were 76.63 ± 78.81 (range, 8∼256) and 162.53 ± 464.1 (0∼2048). We performed preoperative plasma exchange to 16 recipients (mean number of sessions, 3.58; range, 1-10). After surgery, 9 patients received plasma exchange (mean, 1.84; range 1∼14). One death occurred as the result of pneumonia (5.3%). There were 4 cases of acute rejections (21.1%), and all of them were treated successfully with steroid pulse or thymoglobulin. Antibody-mediated rejection and graft failure did not occur. Six cases of postoperative complications (31.6%) occurred, including 3 cases of infections. There were 2 cases of biliary anastomotic stricture (10.5%) and 1 case of portal vein stenosis (5.3%).
  
  
  CONCLUSIONS
  ABOi LDLT with the use of simplified protocol can be safely performed without increased risk of antibody-mediated rejection and other complications.
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: J G
authors.initials: JG
authors.lastname: Lee
authors.affiliation: Department of Surgery, CHA Bundang Medical Center, CHA University, Bundang, Korea.
authors.forename: J J
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: M S
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: M K
authors.initials: MK
authors.lastname: Ju
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: G H
authors.initials: GH
authors.lastname: Choi
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea.
authors.forename: J S
authors.initials: JS
authors.lastname: Choi
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: S I
authors.initials: SI
authors.lastname: Kim
authors.affiliation: Department of Transplantation Surgery, Severance Hospital, Yonsei University Health System, Seoul, Korea; Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea. Electronic address: djjoo@yuhs.ac.
authors.forename: D J
authors.initials: DJ
authors.lastname: Joo
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D058625:End Stage Liver Disease / Q000276:immunology / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange; D000069283:Rituximab / Q000627:therapeutic use; D013156:Splenectomy; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D000069283:Rituximab