Successful ABO-Incompatible Liver Transplantation Using A2 Donors

Skogsberg, U; Breimer, Michael E.; Friman, Styrbjörn; Mjörnstedt, L.; Mölne, Johan; Olausson, Michael; Rydberg, Lennart; Svalander, Christian; Bäckman, Lars

doi:10.1016/j.transproceed.2006.07.025

Cited by 29 publications

(22 citation statements)

References 7 publications

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“…Effective reduction of titers was only sustained by repeated plasmapheresis. After four plasmapheresis sessions, we decided against further treatment because under a favorable donor-recipient blood group combination, that is, mismatches for donor blood group A2 or B [39–41], high pre- and postoperative titer levels may be tolerated without increasing AMR or graft loss [15, 16]. Subsequently no AMR or alteration of graft function was seen in this patient, although the relevant titer (A2) remained elevated for almost half a year before spontaneously declining below pretransplant level (see Figure 2(b)).…”

Section: Discussionmentioning

confidence: 99%

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

Goralczyk

Obed

Schnitzbauer

et al. 2009

Journal of Transplantation

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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.

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Section: Discussionmentioning

confidence: 99%

“…Recently, some authors even report similar outcomes of ABO-incompatible ALDLT as compared to compatible ALDLT [13, 14]. ABO-incompatible ALDLT has subsequently gained acceptance in Europe, namely, in Sweden [15, 16] and Belgium [17]. …”

Section: Introductionmentioning

confidence: 99%

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

Goralczyk

Obed

Schnitzbauer

et al. 2009

Journal of Transplantation

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“…In recent years, promising results with ABO incompatible liver transplantation using A 2 donors (subgroup of A which is less reactive and occur in approximately 20% of group A individuals) have been reported. In a Swedish study of 10 adult blood group O recipients who received A 2 cadaveric grafts, patient and graft survival was 10/10 and 8/10 respectively at 8.5 mo median follow up with tacrolimus based protocol and initial immunosuppression with antithymocyte globulin, interleukin-2-receptor antagonists or anti-CD20 antibody [47] . In 16 pediatric ABOincompatible pediatric liver transplantation, Heffron et al reported one-year actuarial graft survival of 92% utilizing standard immunosuppression with selective postoperative plasmapheresis and without splenectomy [48] .…”

Section: Abo Incompatible Liver Transplantationmentioning

confidence: 99%

Liver transplantation: Yesterday, today and tomorrow

Abbasoğlu¹

2008

WJG

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With the advances in technical skills, management of postoperative complications and improvements in immunosuppressive drugs, liver transplantation is the standard treatment for many patients with chronic liver disease. Today, shortage of donor organs seems to be the major limiting factor for the application of liver transplantation. This review focuses on five issues that are challenging to clinical practice of liver transplantation and relevant to gastroenterologists. These include living donor liver transplantation, recurrent viral hepatitis, non-heart-beating donors, hepatocellular carcinoma, and ABO incompatible liver transplantation. Living donor and non-heart beating donor transplantations were initiated as a solution to increase the donor organ pool and it is expected that there will be an increase in the number of these donors. Recurrent hepatitis C and hepatocellular carcinoma following liver transplantation are among major problems and ongoing research in these diseases may lead to better outcomes in these recipients.

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“…Immunohistochemistry (Figure 4) supports the notion that livers from A2 individuals contain considerably less A antigens than livers from A1 individuals. This may explain reports stating that ABOi LTx can be performed using livers from A2 donors [27,29].…”

Section: Lack Of Knowledge With Regard To the Tissue Distribution Of mentioning

confidence: 95%

Molecular Deciphering of the ABO System as a Basis for Novel Diagnostics and Therapeutics in ABO Incompatible Transplantation

Holgersson¹,

Rydberg²,

Breimer

2013

International Reviews of Immunology

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In recent years ABO incompatible kidney transplantation (KTx) has become a more or less clinical routine procedure with graft and patient survival similar to those of ABO compatible transplants. Antigen-specific immunoadsorption (IA) for anti-A and anti-B antibody removal constitutes in many centers an important part of the treatment protocol. ABO antibody titration by hemagglutination is guiding the treatment; both if the recipient can be transplanted as well as in cases of suspected rejections if antibody removal should be performed. Despite the overall success of ABO incompatible KTx, there is still room for improvements and an extension of the technology to include other solid organs. Based on an increased understanding of the structural complexity and tissue distribution of ABH antigens and the fine epitope specificity of the ABO antibody repertoire, improved IA matrices and ABO antibody diagnostics should be developed. Furthermore, understanding the molecular mechanisms behind accommodation of ABO incompatible renal allografts could make it possible to induce long-term allograft acceptance also in human leukocyte antigen (HLA) sensitized recipients and, perhaps, also make clinical xenotransplantation possible.

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Successful ABO-Incompatible Liver Transplantation Using A2 Donors

Cited by 29 publications

References 7 publications

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

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

Liver transplantation: Yesterday, today and tomorrow

Molecular Deciphering of the ABO System as a Basis for Novel Diagnostics and Therapeutics in ABO Incompatible Transplantation

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