Abstract:
BACKGROUND:Although graft local infusion (GLI) treatment via the portal vein or the hepatic artery has been the pivotal strategy in ABO incompatible (ABOi) living donor liver transplantation (LDLT) in Japan, the procedure is associated with a high rate of catheter-associated complications. METHODS:A new ABOi-LDLT protocol has been implemented using rituximab, intravenous immune globulin (IVIG), plasma exchange (PE), and splenectomy, without using GLI, on four patients, since 2007. Three other patients, treated before 2007, received GLI. RESULTS:Three of the four patients with liver cirrhosis received rituximab over 3 weeks before LDLT, followed by PEs and post-LDLT IVIG, resulting in no rebound elevation of the isoagglutinin titers. The remaining patient, with fulminant hepatitis, received rituximab 3 days before the LDLT, resulting in antibody-mediated rejection, successfully treated by IVIG and PE. All four patients that were treated with the new protocol are alive, 26, 8, 6, and 5 months after ABOi-LDLT with normal liver function. Two of the three other patients with GLI, before 2007, had catheter-associated complications, including one graft loss. CONCLUSION:The new ABOi-LDLT protocol using rituximab, IVIG, and PE, without the use of GLI, therefore seems to be a safe and an effective treatment modality.
journal_name
Transplantationjournal_title
Transplantationauthors
Ikegami T,Taketomi A,Soejima Y,Yoshizumi T,Uchiyama H,Harada N,Iguchi T,Hashimoto N,Maehara Ydoi
10.1097/TP.0b013e3181adcae6subject
Has Abstractpub_date
2009-08-15 00:00:00pages
303-7issue
3eissn
0041-1337issn
1534-6080pii
00007890-200908150-00004journal_volume
88pub_type
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