title: Increasing use of therapeutic apheresis as a liver-saving modality.
abstract: BACKGROUND
  Therapeutic plasma exchange (TPE) is used for temporary support of liver function in patients presenting with early graft dysfunction after liver transplantation (LT) or liver surgery. We analyzed the effect of therapeutic apheresis on patients with liver disease.
  
  
  METHODS
  Between January 2011 and August 2016, 93 apheresis procedures were performed for 26 patients at our institution. Anti-ABO isoagglutination immunoglobulin (Ig) M titer was checked using a type A and type B 3% red blood cell (RBC) suspension in saline with two-fold serial dilutions of patient serum. Anti-ABO isoagglutination IgG titer was checked by a type A and B 0.8% RBC suspension using a low-ionic strength/Coombs card.
  
  
  RESULTS
  ABO-incompatible (ABOi) LT was the most common (n=10, 38.5%) indication for apheresis; early graft dysfunction after LT (n=8, 30.7%) was the second most common. Median initial IgM and IgG anti-ABO titers for ABOi LT recipients were 1:16 (range, 1:8-1:128) and 1:48 (range, 1:8-1:2048). We performed preoperative TPE in 10 recipients (median number of sessions, 1.5; range, 1-11). Among patients with early graft dysfunction, those who underwent living donor LT had better survival (4/4; 100%) than those who underwent nonliving donor LT (0/3; 0%). Patients who underwent living donor LT first and then additional LT also survived after three TPE sessions.
  
  
  CONCLUSIONS
  Therapeutic apheresis is associated with a good survival rate and is essential for liver support in patients with early graft dysfunction after LT or posthepatectomy liver failure and during preparation for ABOi LT.
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea.
authors.forename: Hyun-Ji
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
authors.forename: Kyung-Hwa
authors.initials: KH
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea.
authors.forename: Duyeal
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea.
authors.forename: Sun-Min
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea.
authors.forename: Chulhun L
authors.initials: CL
authors.lastname: Chang
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea; Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
authors.forename: Chong Woo
authors.initials: CW
authors.lastname: Chu
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea; Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
authors.forename: Je Ho
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea; Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
authors.forename: Tae Bum
authors.initials: TB
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea; Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
authors.forename: Yong-Mok
authors.initials: YM
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea; Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Yang
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea; Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
authors.forename: Byung Hyun
authors.initials: BH
authors.lastname: Choi
authors.affiliation: Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea. Electronic address: hhkim@pusan.ac.kr.
authors.forename: Hyung-Hoi
authors.initials: HH
authors.lastname: Kim
mesh_terms: D000368:Aged; D001781:Blood Component Removal / Q000379:methods*; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010951:Plasma Exchange / Q000379:methods*
keywords: Liver; Plasma exchange; Primary graft dysfunction; Transplantation