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Successful ABO-incompatible liver transplantation using A2 donors

Journal article
Authors Ulrika Skogsberg
Michael Breimer
Styrbjörn Friman
Lars Mjörnstedt
J. Molne
Michael Olausson
L. Rydberg
Christian T. Svalander
L. Backman
Published in Transplantation proceedings
Volume 38
Issue 8
Pages 2667-70
ISSN 0041-1345 (Print)
Publication year 2006
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences
Pages 2667-70
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords *ABO Blood-Group System, *Blood Group Incompatibility, Follow-Up Studies, Graft Rejection/prevention & control, Graft Survival, Humans, Liver Transplantation/*immunology/mortality, Male, Middle Aged, Retrospective Studies, Survival Analysis, Time Factors
Subject categories Medical and Health Sciences

Abstract

INTRODUCTION: The longer waiting time for a liver graft among patients with blood group O makes it necessary to expand the donor pool for these patients. We herein have reported our experience with ABO-incompatible liver transplantation using A(2) donors to blood group O recipients. PATIENTS AND METHODS: Between 1996 to 2005, 10 adult blood group O recipients received 10 A(2) cadaveric grafts. Mean recipient age was 52 +/- 7.7 years (mean +/- SD). The initial immunosuppression was induction with antithymocyte globulin (n = 2), interleukin-2-receptor antagonists (n = 3), or anti-CD20 antibody (rituximab, n = 1), followed by a tacrolimus-based protocol. No preoperative plasmapheresis, immunoadsorption, or splenectomies were performed. RESULTS: Patient and graft survival was 10/10 and 8/10, respectively, at 8.5 months median follow-up (range 10 days to 109 months). Two patients were retransplanted because of bacterial arteritis (n = 1) and portal vein thrombosis (n = 1). The six acute rejections, which occurred in four patients, were all reversed by steroids or increased tacrolimus dosages. The pretransplant anti-A titers against A(1) red blood cells were 1:128 (NaCl technique) and 1:8 to 1024 (IAT technique). The maximum postoperative titers were 1:64 to 4000 (NaCl) and 1:256 to 32000 (IAT). CONCLUSION: The favorable outcome of A(2) to O grafting, with a patient survival of 10/10 and graft survival of 8/10, makes it possible to consider this blood group combination also in nonurgent situations. There was no hyperacute rejection or increased rate of rejections. Anti-A/B titer changes seem to not play a significant role in the monitoring of A(2) to O liver transplantation.

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