TY - JOUR
T1 - Successful ABO Incompatible Living Donor Liver Transplantation in a Patient With High Isoagglutinin Titer Using High-Dose Intravenous Immunoglobulin
AU - Ikegami, Toru
AU - Taketomi, A.
AU - Soejima, Yuji
AU - Iguchi, T.
AU - Sanefuji, K.
AU - Kayashima, H.
AU - Yoshizumi, T.
AU - Harada, N.
AU - Maehara, Yoshihiko
PY - 2007/12
Y1 - 2007/12
N2 - 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.
AB - 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.
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U2 - 10.1016/j.transproceed.2007.09.028
DO - 10.1016/j.transproceed.2007.09.028
M3 - Article
C2 - 18089417
AN - SCOPUS:37049032513
SN - 0041-1345
VL - 39
SP - 3491
EP - 3494
JO - Transplantation Proceedings
JF - Transplantation Proceedings
IS - 10
ER -
