ABO-incompatible deceased donor liver transplantation with the use of antigen-specific immunoadsorption and anti-CD20 monoclonal antibody

Clinical Transplantation
K M BobergE Schrumpf

Abstract

In patients with fulminant liver failure requiring emergency liver transplantation, the only donor organ that becomes available may be ABO incompatible. The risk of graft failure because of antibody-mediated acute rejection is high, but can be reduced by various means. We reported a deceased donor ABO-incompatible liver allograft recipient who was treated with antigen-specific immunoadsorption in combination with anti-CD20 monoclonal antibody and conventional plasmapheresis and immunosuppression. The patient was a 33-yr-old male with blood group A who presented with subacute liver failure of unknown aetiology and received a blood group AB liver graft. Pretransplant he underwent plasmapheresis and received one dose of rituximab. The immunosuppressive regimen consisted of methylprednisolone, tacrolimus and mycophenolate mofetil. Despite regular post-operative plasmapheresis sessions, anti-B antibody titres increased. Antigen-specific immunoadsorption with depletion of anti-B antibodies was performed from day nine to day 17. Thereafter, anti-B IgM and IgG antibody titres remained low. After one month the patient was reoperated with hepaticojejunostomy because of bile duct necrosis and with reconstruction of a stenotic hepatic arte...Continue Reading

References

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Citations

Dec 17, 2010·Annals of Biomedical Engineering·Azadeh Alikhani, William J Federspiel
Jun 27, 2008·Transplantation·Valeriya ZarkhinMinnie Sarwal
Oct 2, 2009·Gastroenterology Research and Practice·Kathleen ConnorBrad Butler
Jul 18, 2009·World Journal of Gastroenterology : WJG·Nassim KamarLionel Rostaing
May 25, 2012·Kidney International·Jennifer M DeVosSamir J Patel
Mar 5, 2015·Transplant International : Official Journal of the European Society for Organ Transplantation·Trygve ThorsenWilliam Bennet
Jul 8, 2009·Journal of Biomedical Materials Research. Part B, Applied Biomaterials·Azadeh AlikhaniWilliam J Federspiel
Oct 17, 2007·Transplant International : Official Journal of the European Society for Organ Transplantation·Toru IkegamiYoshihiko Maehara
Sep 19, 2012·Journal of Biomedical Materials Research. Part B, Applied Biomaterials·Azadeh Alikhani, William J Federspiel
Mar 31, 2007·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Hiroto EgawaShinji Uemoto
Sep 16, 2015·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·G-W SongE-Y Tak

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