Adult Living Donor Liver Transplantation Across ABO-Incompatibility.
The objective of this study was to evaluate the results of adult ABO-incompatible living donor liver transplantation (LDLT).ABO-incompatible LDLT is an aggressive treatment that crosses the blood-typing barrier for saving lives from liver diseases. Although graft and patient survival have been improved recently by various treatments, the results of adult ABO-incompatible LDLT require further evaluation.Two regimens were designed based on isoagglutinin IgG and IgM titers and the time course of immunological reactions at this institute. When isoagglutinin IgG and IgM titers were ≤64, liver transplantation was directly performed and rituximab (375 mg/m) was administrated on postoperative day 1 (regimen I). When isoagglutinin titers were >64, rituximab (375 mg/m) was administered preoperatively with or without plasmapheresis and boosted on postoperative day 1 (regimen II). Immunosuppression was achieved by administration of mycophenolate mofetil, tacrolimus, and steroids.Forty-six adult ABO-incompatible and 340 ABO-compatible LDLTs were performed from 2006 to 2013. The Model for End-Stage Liver Disease scores for ABO-incompatible recipients ranged from 7 to 40, with a median of 14. The graft-to-recipient weight ratio ranged from 0.61% to 1.61% with a median of 0.91%. The 1-, 3-, and 5-year survival rates were 81.7%, 75.7%, and 71.0%, respectively, for ABO-incompatible LDLT recipients, compared to 81.0%, 75.2%, and 71.5% for ABO-C recipients (P = 0.912). The biliary complication rate was higher in ABO-incompatible LDLT recipients than in the ABO-compatible recipients (50.0% vs 29.7%, P = 0.009).In the rituximab era, the blood type barrier can be crossed to achieve adult ABO-incompatible LDLT with survival rates comparable to those of ABO-compatible LDLT, but with more biliary complications.
From the Department of Liver and Transplantation Surgery (C-FL, C-HC, Y-CW, T-HW, H-SC, T-JW, K-MC, W-CL), Department of Hepatology, Chang-Gung Memorial Hospital, Linkou, Taiwan (C-SL), Department of General Surgery, Chang-Gung Memorial Hospital, Keelung, Taiwan (R-SS); and Chang-Gung University College of Medicine, Taoyuan, Taiwan (T-JW, K-MC, W-CL).
Chen-Fang
CF
Lee
Chih-Hsien
CH
Cheng
Yu-Chao
YC
Wang
Ruey-Shyang
RS
Soong
Tsung-Han
TH
Wu
Hong-Shiue
HS
Chou
Ting-Jung
TJ
Wu
Kun-Ming
KM
Chan
Ching-Song
CS
Lee
Wei-Chen
WC
Lee
D000017:ABO Blood-Group System / Q000276:immunology*; D001787:Blood Group Incompatibility / Q000401:mortality; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000276:immunology; D015996:Survival Rate
D000017:ABO Blood-Group System