The Role of Plasmapheresis Therapy for Perioperative Management in ABO-Incompatible Adult Living Donor Liver Transplantation

Ashizawa, T.; Matsuno, Naoto; Yokoyama, T.; Kihara, Y.; Kuzuoka, K.; Taira, Satoru; Konno, Osamu; Jyojima, Y.; Akashi, Isao; Nakamura, Yuki; Hama, K.; Iwamoto, Hitoshi; Iwahori, Tohru; Nagao, Toshiyasu; Kasahara, Mureo; Tanaka, Kōichi

doi:10.1016/j.transproceed.2006.10.122

Cited by 9 publications

(8 citation statements)

References 7 publications

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“…6,12,21 Small single-center studies in children undergoing living-related donor transplantation suggest elevation of IH titers after transplantation may be a predictive risk factor for increased mortality and morbidity and the reduction in titers of antidonor blood type antibodies using TPE and rituximab can achieve favorable outcomes. 7,15,23 Including rituximab is critical, in combination with Contrary to the assumption that children under 2 years of age have immature immune systems and they seldom mount antibodies against ABO, in our experience, we found that infants with endstage liver disease can have high IH titers of 1:512. 26 As There are several limitations to this study.…”

Section: Complications Post-transplantcontrasting

confidence: 67%

ABO‐incompatible deceased donor pediatric liver transplantation: Novel titer‐based management protocol and outcomes

Mysore

Himes

Rana

et al. 2018

Pediatric Transplantation

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ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.

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Section: Complications Post-transplantcontrasting

confidence: 67%

ABO‐incompatible deceased donor pediatric liver transplantation: Novel titer‐based management protocol and outcomes

Mysore

Himes

Rana

et al. 2018

Pediatric Transplantation

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“…26,27 In ABO-incompatible transplants, ADI titer less than 1/16 is commonly associated with a minimal risk of acute humoral rejection. 28,29 Therefore, the reduction of immediately pre-LT ADI level may result in longer graft survival. As presented in this study, in the ABO-incompatible group, 6 patients with median age of 0.7 year had an ADI level of 1/16 or less and underwent transplant without a special management, receiving conventional immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Living Donor Liver Transplantation in Children

et al. 2015

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“…Because of reports of high levels of antibody‐mediated rejection (AMR), graft loss, and consequentially poor outcomes, various physicians have recommended that ABOi LDLT be approached with caution and that it only be performed in an urgent situation when a prospective donor is unavailable . Recently, however, successful experiences with ABOi LDLT have been reported due to the implementation of preoperative plasmapheresis and immunosuppression with the anti‐CD20 monoclonal antibody rituximab, suggesting that ABOi LDLT can be a feasible alternative to ABO‐compatible (ABOc) LDLT …”

mentioning

confidence: 99%

Comparison of acute kidney injury between ABO‐compatible and ABO‐incompatible living donor liver transplantation: A propensity matching analysis

et al. 2016

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The anti-CD20 monoclonal antibody rituximab has significantly decreased the prevalence of antibody-mediated rejection of ABO-incompatible (ABOi) living donor liver transplantation (LDLT). However, little is known about acute kidney injury (AKI) following ABOi LDLT. The aim of this study was to identify the incidence of AKI in ABOi LDLT and compare it with that of ABO-compatible (ABOc) LDLT. We retrospectively collected and analyzed the data of 1617 patients who underwent liver transplant surgery from November 2008 to December 2014. Risk factors for AKI were investigated using multivariate regression analysis. In 271 ABOi LDLTs, AKI occurred in 184 (67.9%) according to Kidney Disease: Improving Global Outcomes criteria. After propensity score matching, the incidence of AKI was significantly higher after ABOi LDLT than after ABOc LDLT (67.0% versus 48.2%; P < 0.001). Furthermore, the intensive care unit stay (P = 0.01) was significantly prolonged, but there were no significant differences in mortality (P = 0.74), graft failure (P = 0.32), and postoperative dialysis (P = 0.74) between the 2 groups. Hemoglobin level and operation time were independent risk factors for AKI following ABOi LDLT. In conclusion, the incidence of AKI is higher in ABOi LDLT than ABOc LDLT. However, the impact of AKI on postoperative outcomes was not marked in our study. Therefore, ABOi LDLT in selected patients is promising with apparent good graft and survival outcomes. Liver Transplantation 22 1656-1665 2016 AASLD.

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The Role of Plasmapheresis Therapy for Perioperative Management in ABO-Incompatible Adult Living Donor Liver Transplantation

Cited by 9 publications

References 7 publications

ABO‐incompatible deceased donor pediatric liver transplantation: Novel titer‐based management protocol and outcomes

ABO‐incompatible deceased donor pediatric liver transplantation: Novel titer‐based management protocol and outcomes

Living Donor Liver Transplantation in Children

Comparison of acute kidney injury between ABO‐compatible and ABO‐incompatible living donor liver transplantation: A propensity matching analysis

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