Adult Living Donor Liver Transplantation with ABO-Incompatible Grafts: A German Single Center Experience

Abstract

Adult living donor liver transplantations (ALDLTs) across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins) were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR). Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety.

The impact of rituximab in ABO‐incompatible pediatric living donor liver transplantation: The experience of a single center

“…Accordingly, we have modified the pediatric ABO‐incompatible LDLT protocol. To control ABO antibodies, splenectomy, PE, and the administration of rituximab have been performed . The management of ABO‐incompatible LDLT patients treated at our center is shown in Table .…”

“…The use of extended criteria for the donation of livers has become a necessity in this era of limited availability of organs for transplantation. Therefore, livers from ABO‐incompatible donors are often used as liver grafts . However, ABO‐incompatible LDLT is associated with a low rate of graft survival as a consequence of antibody‐mediated rejection that results in graft failure .…”

“…However, ABO‐incompatible LDLT is associated with a low rate of graft survival as a consequence of antibody‐mediated rejection that results in graft failure . Nevertheless, previous studies have demonstrated improved safety of adult ABO‐incompatible LDLT using concomitant rituximab, IVIG, portal vein infusion, or PE . Few studies have demonstrated strategies for performing pediatric ABO‐incompatible LDLT , and no reports have described the optimal timing and dosage of rituximab administration.…”

Transfusion medicine and solid organ transplant – Update and review of some current issues

“…It has been shown to trigger apoptosis not only in T-cells but also in B-cells 29 and may thus be more effective than rituximab. 30 Important variables affecting transfusion requirements include the severity of disease (Child's classification), preoperative PT, history of abdominal operations, and factor V levels. Other factors identified as independent predictors of transfusion include the preoperative hematocrit value, use of the piggyback transplantation method, and operative time.…”

ABO-Incompatible Living Donor Liver Transplantation in Focus of Antibody Rebound

“…Unlike in Asia, where LDLT and ABOi LDLT are often the only therapeutic option because of religious beliefs, in Western Europe only a few small case series to ABOi LDLT exist [1,13,14]. In Asia, the concept of ABOi LDLT is continuously tracked [15].…”