Successful ABO Incompatible Adult Living Donor Liver Transplantation with New Simplified Protocol without Local Infusion Therapy and Splenectomy.
10.4285/jkstn.2011.25.2.95
- Author:
Gi Won SONG
1
;
Sung Gyu LEE
;
Deok Bog MOON
;
Chul Soo AHN
;
Shin HWANG
;
Ki Hun KIM
;
Tae Yong HA
;
Dong Hwan JUNG
;
Gil Chun PARK
;
Jung Man NAMGUNG
;
Sam Yeol YOON
;
Sung Won JUNG
Author Information
1. Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sglee2@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
ABO incompatibility;
Anti-CD20 monoclonal antibody;
Living donor liver transplantation;
Local infusion therapy
- MeSH:
Adult;
Antibodies, Monoclonal, Murine-Derived;
Bilirubin;
Graft Survival;
Hospital Mortality;
Humans;
Incidence;
Liver;
Liver Transplantation;
Living Donors;
Plasmapheresis;
Prothrombin;
Rejection (Psychology);
Rituximab;
Spleen;
Splenectomy;
Tissue Donors;
Transplants
- From:The Journal of the Korean Society for Transplantation
2011;25(2):95-105
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: Since the time various strategies have been introduced to overcome the ABO-blood barrier including local infusion therapy (LIT), plasmapheresis and rituximab, the graft and patient survival outcome of ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) has remarkably improved. But, the need for LIT under rituximab prophylaxis should be reevaluated because of high incidence of the LIT-related complications. The aim of this study was to verify the safety and efficacy of the protocol without local infusion therapy in ABOi ALDLT. METHODS: From November 2008 to December 2010, 43 cases of ABO-incompatible adult living donor liver transplantation were performed. In all cases, the spleen was preserved. From the 1st to 20th case, LIT was employed (group I, n=20). From the 21th case onwards, LIT was eliminated from the protocol (group II, n=23). The 3-month and 1-year patient and graft survival rates were compared between the two groups. The clinical parameters including recipient, donor and graft-related factors were also compared. The graft function was assessed in each group based on the serial changes in serum AST/ALT, total bilirubin and prothrombin time. RESULTS: There was 1 case of in-hospital mortality (2.3%) among the 43 cases. Overall 3-month and 1-year patient and graft survival rate was 97.7% and 92.1% during a mean period of 11.4 +/- 0.4 (0.9~28.9) months. There was no significant difference in the 3-month and 1-year patient and graft survival rates (95.0 vs. 100% and 90.0 vs. 92.9%, P=0.60) between groups. LIT-related complications occurred in 4 patients (20.0%). One case of antibody-mediated rejection occurred in group II. Both groups showed no difference in graft function at postoperative 3rd month. CONCLUSIONS: ABOi ALDLT without splenectomy and LIT resulted in promising outcomes. Therefore, LIT can be safely eliminated from the protocol.
