ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes.

Abstract:

:ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.

journal_name

Pediatr Transplant

authors

Mysore KR,Himes RW,Rana A,Teruya J,Desai MS,Srivaths PR,Zaruca K,Calvert A,Guffey D,Minard CG,Morita E,Hensch L,Losos M,Kostousov V,Hui SR,Orange JS,Goss JA,Nicholas SK

doi

10.1111/petr.13263

subject

Has Abstract

pub_date

2018-11-01 00:00:00

pages

e13263

issue

7

eissn

1397-3142

issn

1399-3046

journal_volume

22

pub_type

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