title: The changes in treatment strategies in ABOi living donor liver transplantation for acute liver failure.
abstract: BACKGROUND
  Living donor liver transplantation (LDLT) using ABO-incompatible (ABOi) graft for acute liver failure (ALF) is a developing treatment modality.
  
  
  METHODS
  We reviewed the changes in our treatment strategies in applying ABOi LDLT for FH over our fourteen years of experience.
  
  
  RESULTS
  Five patients with ALF received LDLT in adults using ABOi grafts, with different but gradually renewed protocols. The etiologies for acute liver failure included autoimmune hepatitis (n=3) and unknown (n=2). The desensitization protocol for ABOi barrier included Case #1; local infusion (portal vein)+plasma exchange (PE), Case #2; local infusion (hepatic artery)+rituximab+PE, Case #3 and #4; rituximab+PE, and Case #5; rituximab+PE under high-flow continuous hemodiafiltration. Local infusion was abandoned since Case #3, because Case #1 had portal vein thrombosis resulting in graft necrosis and Case #2 had hepatic artery dissection. The patients (Case #2 and #3), who received rituximab within 7 days before LDLT, experienced antibody-mediated rejection. Thus, the most recent protocol for ABOi-LDLT is that rituximab is given 2 weeks before LDLT, followed by high-flow continuous hemodiafiltration to obstacle hepatic encephalopathy until LDLT. The four patients except Case #1 are doing well with good graft function over 3.8±3.7 years.
  
  
  CONCLUSIONS
  Rituximab-based ABOi-LDLT, most-recently under high-flow hemodiafiltration for treating encephalopathy, is a feasible option for applying LDLT for ALF.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University.
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yasuda
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Daisuke
authors.initials: D
authors.lastname: Imai
authors.forename: Huanlin
authors.initials: H
authors.lastname: Wang
authors.forename: Yuki
authors.initials: Y
authors.lastname: Bekki
authors.forename: Shinji
authors.initials: S
authors.lastname: Itoh
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D017583:Hemodiafiltration; D006501:Hepatic Encephalopathy / Q000628:therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged; D000069283:Rituximab / Q000627:therapeutic use
chemical_list: D000017:ABO Blood-Group System; D000069283:Rituximab