ABO-mismatch adult living donor liver transplantation using antigen-specific immunoadsorption and quadruple immunosuppression without splenectomy

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Roberto TroisiBernard de Hemptinne

Abstract

ABO-incompatible (ABO-I) liver transplantation is a controversial issue because of the generally less favorable outcome as compared to compatible transplants. Encouraging results have been shown by the introduction of new strategies to reduce posttransplant-specific hemagglutinin (HA) titers with plasmapheresis, reinforced immunosuppression (IS), and the use of splenectomy. We describe a new protocol consisting of daclizumab (DAC) induction, mycophenolate mofetil (MMF)/tacrolimus (TAC)/steroids without splenectomy. Five recipients (mean age of 47 +/- 14 yr) undergoing ABO-I living donor liver transplantation (LDLT) were included in this protocol. Immunoadsorbent columns (Glycosorb ABO) were used for antigen-specific immunoadsorption (ASI). The median follow-up was 18.5 +/- 10.5 months. ASI was very efficient in lowering HA titers (mean log(2) immunoglobulin [Ig] M [IgM] and IgG values before and after ASI were 5.9 +/- 2.8 and 1.2 +/- 1.4 [P= 0.0038] and 6.5 +/- 2.3 and 1.1+/- 1.9, respectively [P= 0.0001]). Persisting low HA titers were observed over time. No sepsis nor cytomegalovirus infection episodes were recorded. Acute cellular rejection (ACR) occurred in 1 recipient responding to steroid pulse therapy. Two grafts were lo...Continue Reading

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Apr 9, 2008·Journal of Hepato-biliary-pancreatic Surgery·Hiroto EgawaKazue Ozawa
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