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Adult ABO-incompatible liver transplantation, using A and B 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 Xenotransplantation
Volume 13
Issue 2
Pages 154-9
ISSN 0908-665X (Print)
Publication year 2006
Published at Institute of Clinical Sciences
Pages 154-9
Language en
Links www.ncbi.nlm.nih.gov/entrez/query.f...
Keywords ABO Blood-Group System/*immunology, Adult, Biliary Tract Diseases/etiology, Blood Group Incompatibility/complications/*immunology, Female, Graft Rejection/immunology, Graft Survival/immunology, Humans, Liver Transplantation/*immunology, Male, Middle Aged, *Tissue Donors, Treatment Outcome
Subject categories Medical and Health Sciences

Abstract

BACKGROUND: The longer waiting time for a liver graft in patients with blood group O makes it necessary to expand the donor pool for these patients. This applies in both urgent situations and for elective patients. We report on our experience with ABO-incompatible liver transplantation using A2 and B non-secretor donors here. PATIENTS AND METHODS: Between 1996 and 2005, 12 adult blood group O recipients (seven male/five female) received ABO-incompatible cadaveric liver grafts (10 A2 donors, two B non-secretor donors). The indications were either rapid deterioration of liver function or hepatocellular cancer, in blood group O recipients, where an ABO-identical/compatible graft was not available. Mean recipient age was 54+/-8 (mean+/-SD) yr. All pre-operative CDC crossmatches were negative. The initial immunosuppression was induction therapy with antithymocyte globulin (n = 3), interleukin 2 receptor antagonists (n = 3) or anti-CD20 antibody (rituximab) (n = 1), followed by a tacrolimus-based protocol. Three patients underwent plasmapheresis post-transplantation. Baseline biopsies were taken before or immediately after reperfusion of the graft and after grafting when clinically indicated. No pre-operative plasmapheresis, immunoadsorption or splenectomies were performed. RESULTS: Patient and graft survival was 10/12 (83%) and 8/12 (67%), respectively, with a 6.5-month median follow-up (range 10 days to 109 months). Two patients (B non-secretor grafts) died of multiorgan failure probably because of a poor condition before transplantation. Three patients were retransplanted. Causes of graft loss were bacterial arteritis (n = 1), death with a functioning graft (n = 1) and portal vein thrombosis (n = 2). In one of the patients with portal vein thrombosis, an anti-A titer increase occurred concomitantly, and ABO incompatibility as the cause of the thrombosis cannot be excluded. Seven acute rejections occurred in five patients and all were reversed by steroids or increased tacrolimus dosage. The pre-transplant anti-A titers tested against A1 red blood cells were 1 to 128 (NaCl technique) and 4 to 1024 (indirect antiglobulin technique, IAT); the maximum postoperative titers were 16 to 2048 (NaCl) and 256 to 32,000 (IAT). CONCLUSION: The favorable outcome of A2 to O grafting, with a patient survival of 10/10 and a graft survival of 8/10, makes it possible to also consider this blood group combination in non-urgent situations. The use of non-secretor donor grafts is interesting but has to be further documented. There was no hyperacute rejection or increased rate of rejection. Anti-A/B titer changes seem not to play a significant role in the monitoring of ABO-incompatible liver transplantation.

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