Successful Experiences of ABO-Incompatible Adult Living Donor Liver Transplantation In a Single Institute: No Immunological Failure in 10 Consecutive Cases
Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea. Electronic address: .Transplantation Proceedings (Impact Factor: 0.98). 02/2013; 45(1):272-5. DOI: 10.1016/j.transproceed.2012.06.079
ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) is a feasible therapeutic option for countries with a scarcity of deceased donors. This report presents our initial experiences in ABOi ALDLT in 10 patients between December 2008 and September 2009. The mean age of recipients was 48.5 ± 5.7 years (range, 40-54 years). The mean Model for End-stage Liver-Disease score was 13.9 ± 4.0 (range, 9-22). All patients were administered preoperative rituximab once and plasma exchanges according to the hemagglutinin titer. The spleen was preserved in all cases. For local infusion therapy, hepatic arterial infusion was performed in 9 patients and portal vein infusion in 1 subject. The 10 patients experienced no in-hospital mortality. At a mean follow-up period of 31.8 ± 2.9 months (range, 4.1-34.9 months), 1 patient has died (postoperative month 4 due to sepsis following a biliary stricture. The 3-month patient and graft survivals were 100%, and 1- and 2-year survivals, 90.0%. There was no episode of antibody-mediated rejection. The promising results of our initial experience may have been due to the use of preoperative rituximab and the good preoperative conditions of the patients.
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ABSTRACT: The aim of our present study was to review the experiences of a living donor-dominant transplantation program for children with acute liver failure (ALF). Data were derived from the retrospective chart review of 50 children with ALF in a major liver center, Korea. A total of 50 children with ALF underwent 47 (94%) primary living donor liver transplantations and 3 (6%) cadaveric liver transplantations. The cumulative survival rates of the grafts at 1 and 5 years were 81.9% and 79.2%, respectively. The overall retransplantation rate was 12%. The cumulative survival rates of these patients at 1 and 5 years were all 87.9%. Most incidents of mortality followed the failure of the preceding graft. We observed no mortalities among donors. Based on multivariate analysis, children who had pretransplant thrombocytopenia or had to use the molecular adsorbent recycling system preoperatively were related to the graft loss. Age <2 years and a hyperacute onset (within 7 days) of hepatic encephalopathy were associated with pretransplant thrombocytopenia. Living donor-dominant transplantation program in the present study demonstrates tolerable achievements in terms of clinical outcomes of recipients and donors. However, putative factors, such as pretransplant thrombocytopenia, seem to play unclear roles in a poor prognosis following transplantation.
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ABSTRACT: For single hepatocellular carcinoma(HCC), hepatic resection (HR) is regarded as the treatment of choice regardless of size when hepatic function is preserved. Systematic HR is preferred, but an individual patient-customized treatment plan for HR is essential to ensure patient safety as well as to achieve oncologic curability. HR can offer an acceptable survival outcome for patients with small oligo-nodular HCCs and well-preserved liver function. For HCC patients with portal vein tumor thrombus, HR with thrombus removal can lead to improved outcomes comparing with non-surgical treatments. Liver transplantation (LT) is a treatment that offers a chance of a cure for HCC and the underlying liver cirrhosis simultaneously, but the availability of liver grafts and the aggressi-veness of tumor recurrence are critical limiting factors of LT for patients with HCC. In Korea, the shortage of deceased donors and strong demand for LT has led to the development of living-donor LT. Considering that HCC recurrence is the most common cause of post-transplant patient death, recipient candidates should be prudently selected through objectively established criteria. The eligibility criteria for LT for HCC are likely to be expanded, but this will require further qualified risk-benefit analyses. HR and LT have complementary roles; thus they should be considered associated treatments rather than mutually exclusive alternatives. A multi-modality treatment strategy, especially for patients with advanced HCC, provides new fields of investigation for diverse indications of HR and LT.
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ABSTRACT: ABO incompatibility is the commonest reason for rejection of donors in living donor liver transplantation (LDLT). The donor pool could be expanded by 25 % to 35 % if the ABO barrier is overcome. In the absence of pre-conditioning, transplantation across the blood groups is fraught with the almost universal risk of antibody-mediated rejection (AMR) that rapidly leads to graft loss. However, AMR can be prevented by removal of preformed antibodies and reducing their production by B cells. We describe our initial experience of three cases of ABO-incompatible (ABO-i) LDLT: a 42-year-old male, an 8-month-old male and a 28-month-old female, all of blood group O+ who received blood group B + right lobe, B + left lateral segment, and A + left lateral segment liver grafts, respectively. Pre-LDLT conditioning included administration of anti-CD20 antibody (Rituximab(®)) to the adult 4 weeks prior, and four to seven sessions of double-filtration plasmapheresis to all, to remove preformed antibodies and achieve anti-donor blood group antibody (ADA) titers of ≤1:16 IgG and ≤1:8 IgM, respectively. In addition, cases 1 and 3 received mycophenolate mofetil for 7 days prior to LDLT. After LDLT, all three patients achieved normal graft function over 8-17 days with no evidence of AMR and without the need for further plasmapheresis. Postoperative complications included portal vein thrombosis (one successfully re-explored), CMV (one), Pseudomonas and Klebsiella sepsis (one each), and abdominal collection (one treated with percutaneous drainage). All are currently well with normal graft function and low ADA titers at 8, 16, and 19 months after ABO-i LDLT.
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