Role of Apheresis and Dialysis in Pediatric Living Donor Liver Transplantation: A Single Center Retrospective Study

Sanada, Yukihiro; Mizuta, Koichi; Urahashi, Taizen; Ihara, Yoshiyuki; Wakiya, Taiichi; Okada, Noriki; Yamada, Naoya; Koinuma, Toshitaka; Koyama, Kansuke; Tanaka, Shinichiro; Misawa, Kazuhisa; Wada, Masahiko; Nunomiya, Shin; Yasuda, Yoshikazu; Kawarasaki, Hideo

doi:10.1111/j.1744-9987.2012.01079.x

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…Sanada et al . 102 successfully performed ABOi, living donor liver transplantation in 11 pediatric patients following PE or DFPP and rituximab pretransplantation and splenectomy post-transplantation. Song et al .…”

Section: Outcomes Of Transplantation After Desensitizationmentioning

confidence: 99%

“…Desensitization for ABOi transplants in other organs is limited to post-transplant treatment with the exception of partial lung and liver transplants from living donors. Sanada et al (102) successfully performed ABOi, living donor liver transplantation in 11 pediatric patients following PE or DFPP and rituximab pretransplantation and splenectomy post-transplantation. Song et al (103) performed ABOi living donor liver transplants in 10 adults following PE and rituximab but without splenectomy.…”

Section: Desensitization For Abo Antibodymentioning

confidence: 99%

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Desensitization for solid organ and hematopoietic stem cell transplantation

Zachary

Leffell

2014

Immunological Reviews

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Desensitization protocols are being used worldwide to enable kidney transplantation across immunologic barriers, i.e. antibody to donor HLA or ABO antigens, which were once thought to be absolute contraindications to transplantation. Desensitization protocols are also being applied to permit transplantation of HLA mismatched hematopoietic stem cells to patients with antibody to donor HLA, to enhance the opportunity for transplantation of non-renal organs, and to treat antibody-mediated rejection. Although desensitization for organ transplantation carries an increased risk of antibody-mediated rejection, ultimately these transplants extend and enhance the quality of life for solid organ recipients, and desensitization that permits transplantation of hematopoietic stem cells is life saving for patients with limited donor options. Complex patient factors and variability in treatment protocols have made it difficult to identify, precisely, the mechanisms underlying the downregulation of donor-specific antibodies. The mechanisms underlying desensitization may differ among the various protocols in use, although there are likely to be some common features. However, it is likely that desensitization achieves a sort of immune detente by first reducing the immunologic barrier and then by creating an environment in which an autoregulatory process restricts the immune response to the allograft.

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Section: Outcomes Of Transplantation After Desensitizationmentioning

confidence: 99%

Section: Desensitization For Abo Antibodymentioning

confidence: 99%

Desensitization for solid organ and hematopoietic stem cell transplantation

Zachary

Leffell

2014

Immunological Reviews

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“…In this case, the abdominal fascia could not be closed during LDLT; instead, the case required secondary skin closure. In cases involving pediatric LDLT patients, apheresis and dialysis are reportedly effective[ 16 ]. Aggressive water removal using CHDF was required in this case.…”

Section: Discussionmentioning

confidence: 99%

Rescue case of low birth weight infant with acute hepatic failure

Okada

Sanada

Urahashi

et al. 2017

WJG

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We report a case involving a rescued low birth weight infant (LBWI) with acute liver failure. Case: The patient was 1594 g and 323/7 gestational wk at birth. At the age of 11 d, she developed acute liver failure due to gestational alloimmune liver disease. Exchange transfusion and high-dose gamma globulin therapy were initiated, and body weight increased with enteral nutrition. Exchange transfusion was performed a total of 33 times prior to living donor liver transplantation (LDLT). Her liver dysfunction could not be treated by medications alone. At 55 d old and a body weight of 2946 g, she underwent LDLT using an S2 monosegment graft from her mother. Three years have passed with no reports of intellectual disability or liver dysfunction. LBWIs with acute liver failure may be rescued by LDLT after body weight has increased to over 2500 g.

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“…The management of ABO‐incompatible LDLT patients treated at our center is shown in Table . The indications for PE have previously been reported . The indication of splenectomy for ABO‐incompatible LDLT is now controversial .…”

Section: Discussionmentioning

confidence: 99%

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

Okada

Sanada

Hirata

et al. 2015

Pediatric Transplantation

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Previous studies have demonstrated the safety of ABO-incompatible pediatric LDLT using preoperative plasmapheresis and rituximab; however, no reports have described the timing and dosage of rituximab administration for pediatric LDLT. This study aimed to describe a safe and effective dosage and timing of rituximab for patients undergoing pediatric ABO-incompatible LDLT based on the experience of our single center. A total of 192 LDLTs in 187 patients were examined. These cases included 29 ABO-incompatible LDLTs in 28 patients. Rituximab was used beginning in January 2004 in recipients older than two yr of age (first period: 375 mg/m(2) in two cases; second period: 50 mg/m(2) in two cases; and 200 mg/m(2) in eight cases). Two patients who received 375 mg/m(2) rituximab died of Pneumocystis carinii pneumonia and hemophagocytic syndrome. One patient who received 50 mg/m(2) rituximab required retransplantation as a consequence of antibody-mediated complications. All eight patients administered 200 mg/m(2) survived, and the mean CD20(+) lymphocyte count was 0.1% at the time of LDLT. In the preoperative management of patients undergoing pediatric ABO-incompatible LDLT, the administration of 200 mg/m(2) rituximab three wk prior to LDLT was safe and effective.

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Role of Apheresis and Dialysis in Pediatric Living Donor Liver Transplantation: A Single Center Retrospective Study

Cited by 4 publications

References 25 publications

Desensitization for solid organ and hematopoietic stem cell transplantation

Desensitization for solid organ and hematopoietic stem cell transplantation

Rescue case of low birth weight infant with acute hepatic failure

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

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