Successful ABO-incompatible pediatric liver transplantation utilizing standard immunosuppression with selective postoperative plasmapheresis

Abstract

Transplanting blood group A, B, or O (ABO)-incompatible (ABO-I) liver grafts has resulted in lower patient and graft survival with an increased incidence of vascular and biliary complications and rejection. We report that, without modification of our standard immunosuppression protocol, crossing blood groups is an acceptable option for children requiring liver transplantation. In our study, ABO-I liver grafts-regardless of recipient age-have comparable long-term survival (mean follow-up of 3.25 yr) with ABO-compatible grafts without any difference in rejection, vascular or biliary complications. From January 1, 1999 to October 1, 2005, we studied 138 liver transplants in 121 children: 16 (13.2%) received an ABO incompatible liver allograft. One-year actuarial patient survival for ABO-matched grafts vs. ABO-I grafts was 93.0% and 100%, respectively, whereas graft survival was 83.4% and 92.3%. Additionally, 6 of 16 (37.5%) ABO-I transplanted children had 8 rejection episodes, whereas 47 patients (44.8%) had 121 rejection episodes in the ABO-compatible group. There were no vascular complications and 2 biliary strictures in the ABO-I group. Plasmapheresis was not used for pretransplantation desensitization and was only required in 1 posttransplantation recipient. No child was splenectomized. Six of the 16 children were older than 13 yr of age, suggesting the possibility of successfully expanding this technique to an older population. In conclusion, our outcomes may support the concept of using ABO-I grafts in a more elective setting associated with split and living donor liver transplants. Liver Transpl 12:972-978, 2006.

Matching donor to recipient in liver transplantation: Relevance in clinical practice

“…Earlier studies had reported increased risk of humoral and cellular rejection, arterial thrombosis and biliary complications after ABO incompatible liver transplants (ABOiLT) [53] . Measures such as peri-operative plasmapheresis [54] , and rituximab [55] have been used to lower peri-operative recipient antibody levels and thereby decrease the risk of these complications. ABOiLT in the pediatric population has been used more frequently and outcomes similar to ABO compatible LT have been achieved [56] .…”

Liver transplantation: Yesterday, today and tomorrow

“…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] . Plasmapheresis may be useful by reducing the recipients' antibody titers before and after transplantation.…”

Recipient Outcomes after ABO-Incompatible Liver Transplantation: A Systematic Review and Meta-Analysis

“…Particularly in recent years, advanced new immunosuppressive agents are developed, patient and graft survival rate after ILT has increased dramatically. However, high risk of complication after ILT, such as biliary complication[7], acute rejection[6], [8], [9] and hepatic artery thrombosis, is still a vital issue related to ILT.…”