Successful ABO Incompatible Living Donor Liver Transplantation in a Patient With High Isoagglutinin Titer Using High-Dose Intravenous Immunoglobulin

T. Ikegami, A. Taketomi, Y. Soejima, T. Iguchi, K. Sanefuji, H. Kayashima, T. Yoshizumi, N. Harada, Y. Maehara

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The optimal management in living donor liver transplantation using an ABO incompatible donor with a high isoagglutinin titer is still uncertain. Our patient was a 20-year-old woman with fulminant hepatitis. The only available donor was her 54-year-old father-in-law of an incompatible blood type. The initial isoagglutinin titer was 2048×. She received 375 mg/m2 of anti-CD20 antibody 3 days before the living donor liver transplantation with concomitant splenectomy. Despite daily plasma exchanges after transplantation, the isoagglutinin titer started to shoot up to its maximum value of 2048×, with a sudden decline in the bile output. High-dose intravenous immunoglobulin (0.6 g/kg) was given after the plasma exchanges; thereafter, her liver function tests stabilized without a further increase in the isoagglutinin titer. We showed the effectiveness of high-dose intravenous immunoglobulin for the management of the rebound elevation of isoagglutinin titer. The combination of anti-CD20 antibody and daily plasma exchanges seemed ineffective for such a situation. This strategy might be another management option for ABO incompatible liver transplantation.

Original languageEnglish
Pages (from-to)3491-3494
Number of pages4
JournalTransplantation Proceedings
Issue number10
Publication statusPublished - Dec 1 2007


All Science Journal Classification (ASJC) codes

  • Surgery
  • Transplantation

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