title: Efficacy of single, extended and goal directed immunoadsorption in ABO incompatible living related donor liver transplantation.
abstract: BACKGROUND
  Liver transplantation is one of the solid organs most commonly being transplanted across the world. The indications, affordability and accessibility have grown manifold. To increase the donor pool, inclusion of ABO incompatible liver donors is being considered. To enhance the graft functioning and survival, immunoadsorption apheresis to reduce the ABO hemagglutination titres are on the rise.
  
  
  METHODS
  We report three cases ABO incompatible liver transplantation with immunoadsorption protocol. The patients were in poor general condition with Child-Turcotte-Pugh (CTP) class 'C' and there were no suitable ABO compatible grafts at the time. For all three cases, immunosuppressive protocol consisted of induction with Rituximab, followed by tacrolimus, mycophenolate mofetil and corticosteroids. The third patient received basiliximab for induction, in addition to the above protocol. First 2 patients received 1 immunoadsorption (IA) session with Glycosorb ABO® system (Glycorex AB, Sweden), pre-operatively. The third patient received 2 IA sessions pre-operatively. Baseline IgM plus IgG titres were 1024; 64 and 1024 for anti-B, anti-A and anti-B for patient 1, 2 and 3 respectively. Target pre-operative antibody titre was ≤16. Average post-operative length of stay was 17.3 days. There were no acute rejection. None of them, required any post-operative plasma exchange.
  
  
  CONCLUSIONS
  Immunoadsorption is effective in reducing hemagglutination titres in recipients of ABO incompatible donor liver.
authors.affiliation: Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
authors.forename: R N
authors.initials: RN
authors.lastname: Makroo
authors.affiliation: Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India. Electronic address: doctorsoma86@gmail.com.
authors.forename: Soma
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
authors.forename: Mohit
authors.initials: M
authors.lastname: Chowdhry
authors.affiliation: Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
authors.forename: Brinda
authors.initials: B
authors.lastname: Kakkar
authors.affiliation: Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
authors.forename: Uday K
authors.initials: UK
authors.lastname: Thakur
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000327:Adsorption; D001787:Blood Group Incompatibility / Q000276:immunology*; D005260:Female; D006040:Goals; D006801:Humans; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System
keywords: ABO incompatible; Immunoadsorption; Therapeutic apheresis