title: ABO-Incompatible Living Donor Liver Transplantation in Focus of Antibody Rebound.
abstract: BACKGROUND
  Living donor liver transplantation (LDLT) is an option to expand the donor organ pool for patients with life-threatening diseases who cannot be supplied with a cadaver organ. Next to the donor risks, complications after ABO-incompatible LDLT (ABOi LDLT) in the recipient are subject to controversial discussion. Improvement in ABOi graft survival rates have been achieved with plasma treatment procedures (PTP) and immunosuppression but antibody-mediated rejection (AMR) and graft loss still occur.
  
  
  METHODS
  Since 2008, we have prepared 10 patients for ABOi LDLT. Seven of the 10 patients for transplantation had hepatocellular carcinoma (HCC).
  
  
  RESULTS
  All patients underwent PTP before and after ABOi LDLT as well as immunosuppression according to the treatment schedule. We did not use anti-CD20 monoclonal antibodies in the transplant setting. We transplanted 6 of 10 preconditioned patients. After 3 years, 5 of the 6 transplanted patients were still alive.
  
  
  CONCLUSIONS
  Even if B-cell depletion with anti-CD 20 treatment in the setting of ABOi LDLT is commonly accepted, our center successfully administered only quadruple drug immunosuppression combined with PTP. Especially patients with HCC had a high titer increment also pre-transplantation and were at high risk for arterial thrombosis and graft loss.
authors.affiliation: Institute of Transfusion Medicine, University Hospital Jena, Jena, Germany.
authors.forename: Silke
authors.initials: S
authors.lastname: Rummler
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Bauschke
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Baerthel
authors.affiliation: Institute of Transfusion Medicine, University Hospital Jena, Jena, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Juette
authors.affiliation: Institute of Transfusion Medicine, University Hospital Jena, Jena, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Maier
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Malessa
authors.affiliation: Institute of Transfusion Medicine, University Hospital Jena, Jena, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Barz
authors.affiliation: Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany.
authors.forename: Utz
authors.initials: U
authors.lastname: Settmacher
keywords: ABO incompatibility; Antibody rebound; Liver; Transplantation