Living-donor Sequential ABO-incompatible Kidney Transplantation after Liver Transplantation in a Patient with Alcoholic Liver Cirrhosis and End-stage Renal Disease.
10.4285/jkstn.2015.29.1.28
- Author:
Jin Ho KWAK
1
;
Hyuk Jai JANG
;
Gun Moo CHOI
;
Chun Soo PARK
;
Dae Woon EOM
;
Seong Su KIM
;
Duck Jong HAN
;
In Koo KIM
Author Information
1. Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea. jhj@gnah.co.kr
- Publication Type:Case Report
- Keywords:
Sequential ABO-incompatible kidney transplantation;
Liver transplantation;
Bleeding complication
- MeSH:
Blood Transfusion;
Hemorrhage;
Hospitalization;
Humans;
Immunoglobulins;
Kidney;
Kidney Failure, Chronic*;
Kidney Transplantation*;
Liver;
Liver Cirrhosis, Alcoholic*;
Liver Transplantation*;
Middle Aged;
Nuclear Family;
Prednisolone;
Rituximab;
Siblings;
Tacrolimus;
Tissue Donors;
Transplants
- From:The Journal of the Korean Society for Transplantation
2015;29(1):28-32
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 47-year-old man developed chronic alcoholic liver cirrhosis and end-stage renal disease. He underwent blood-type-compatible liver transplantation with a graft from his daughter. After 8 months, sequential ABO-incompatible (ABOi) kidney transplantation was performed, with his brother as the donor (A to O). The patient had anti-A antibody titers (1:256). We performed pretransplant desensitization, including administration of rituximab, mycophenolate mofetil, tacrolimus, and prednisolone 2 weeks before the scheduled transplantation, and plasmaphresis (PP) and administered an intravenous immunoglobulin injection. The patient underwent PP before kidney transplantation until the anti-A antibody titer was <1:8. The patient achieved normal renal function within 4 posttransplantation days. Postoperative bleeding (diffuse hemorrhage) requiring additional blood transfusions and radiological intervention (drainage procedure) occurred 9 days after transplantation. The patient was discharged on day 20 of hospitalization. Nine months after the kidney transplantation, the recipient's and donor's liver and kidney functions were normal. ABOi renal transplantation after liver transplantation can be successfully performed in patients with high baseline anti-ABO antibody titers after preconditioning with rituximab and PP, and quadruple immunosuppressive therapy. However, caution is required regarding an increased risk of bleeding complications.
