Strategic breakthrough in adult ABO-incompatible living donor liver transplantation

Preliminary results of consecutive seven cases

Yuji Soejima, Jyun Muto, Rumi Matono, Mizuki Ninomiya, Tetsuo Ikeda, Tomoharu Yoshizumi, Hideaki Uchiyama, Toru Ikegami, Ken Shirabe, Yoshihiko Maehara

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

ABO-incompatibility is a major obstacle to expanding exiguous donor pools in adult liver transplantation, especially in countries where grafts from deceased donors are uncommon. We present our preliminary results of ABO-incompatible (ABO-I) adult living donor liver transplantation (LDLT) using a new, simple protocol. Seven consecutive cases of ABO-I LDLT were managed by the same protocol including pre-operative administration of a single dose of rituximab (375 mg/m 2 ) followed by three to five sessions of plasma exchange before LDLT without portal infusion therapy. The triple immunosuppression protocol consisted of tacrolimus, mycophenolate mofetil and steroids, with mycophenolate mofetil starting seven d before LDLT. Splenectomy was performed for all cases. All patients are alive (100% survival) with a mean follow-up of 852 d (715-990 d). Neither antibody-mediated nor hyperacute rejection were encountered. There was only one episode of mild acute cellular rejection, for which steroid augmentation was effective. The median preformed isoagglutinin antibody titer before plasma exchange was 256, while the median antibody titer immediately before LDLT was 16. In conclusion, adult ABO-I LDLT results were excellent - comparable or even superior to those of ABO-compatible LDLT. ABO-I adult LDLT has now become a more applicable modality without the need for an appropriate donor.

Original languageEnglish
Pages (from-to)227-231
Number of pages5
JournalClinical Transplantation
Volume27
Issue number2
DOIs
Publication statusPublished - Mar 1 2013

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Living Donors
Liver Transplantation
Mycophenolic Acid
Plasma Exchange
Tissue Donors
Antibodies
Steroids
Tacrolimus
Splenectomy
Immunosuppression
Transplants
Survival

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Strategic breakthrough in adult ABO-incompatible living donor liver transplantation : Preliminary results of consecutive seven cases. / Soejima, Yuji; Muto, Jyun; Matono, Rumi; Ninomiya, Mizuki; Ikeda, Tetsuo; Yoshizumi, Tomoharu; Uchiyama, Hideaki; Ikegami, Toru; Shirabe, Ken; Maehara, Yoshihiko.

In: Clinical Transplantation, Vol. 27, No. 2, 01.03.2013, p. 227-231.

Research output: Contribution to journalArticle

Soejima, Yuji ; Muto, Jyun ; Matono, Rumi ; Ninomiya, Mizuki ; Ikeda, Tetsuo ; Yoshizumi, Tomoharu ; Uchiyama, Hideaki ; Ikegami, Toru ; Shirabe, Ken ; Maehara, Yoshihiko. / Strategic breakthrough in adult ABO-incompatible living donor liver transplantation : Preliminary results of consecutive seven cases. In: Clinical Transplantation. 2013 ; Vol. 27, No. 2. pp. 227-231.
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