A novel protocol for ABO incompatible living donor liver transplantation without graft local infusion and splenectomy
Seung Duk Lee, Seong Hoon Kim, Young-Kyu Kim;
Liver Cancer Center, National Cancer Center, Republic of Korea, Goyang-si, Republic of Korea
Background: Graft local infusion and splenectomy have been established as pivotal strategies in ABO incompatible (ABO-I) living donor liver transplantation (LDLT). However, these procedures are associated with high rates of intraoperative and postoperative complications. Methods: From January 2012 to January 2013, 13 consecutive ABO-I LDLT patients were identified at National Cancer Center, Republic of Korea. Our protocol involved rituximab (300 mg/m2) at preoperative 2 weeks, followed by plasma exchange (target before LDLT: isoagglutinin titer ≤ 1:8), basiliximab (20 mg on operation day and postoperative day 4), and intravenous immune globulin (0.8 g/day at postoperative day 1 and 4) without graft local infusion and splenectomy. Results: The 13 patients (10 males, three females) who underwent transplantation comprised liver cirrhosis (n=3) and hepatocellular carcinoma (n = 10). The median isoagglutinin antibody titer before plasma exchange was 1:32 (range, 1:4 - 1:256). All patients are alive without graft failure. There was no hyperacute rejection and antibody-mediated rejection. Mean duration of hospital stay was 13.2 days. There was no recurrence of hepatitis B virus (0/10 patients), but recurrence of hepatitis C virus (1/1 patient) and one positive CMV antigenemia (1/13 patients) after transplantation. No bacterial and fungal infections were observed. Complications included herpes zoster viral infection in one patient, postoperative bleeding in one patient and extrahepatic biliary stricture in three patients. Conclusions: The new simplified ABO-I LDLT protocol using rituximab, plasma exchange, basiliximab, and intravenous immune globulin without graft local infusion and splenectomy showed good graft outcomes without hyperacute, antibody mediated rejection, and serious infection.
The following people have nothing to disclose: Seung Duk Lee, Seong Hoon Kim, Young-Kyu Kim