Six consecutive cases of successful adult ABO-incompatible living donor liver transplantation: a proposal for grading the severity of antibody-mediated rejection

Transplantation
Daisuke MoriokaHiroshi Shimada

Abstract

The clinical symptoms, histological findings, and treatments for antibody-mediated rejection (AMR), which is the leading cause of graft loss in adult ABO-incompatible liver transplantation (ABO-I-LT), have rarely been discussed. We performed adult living donor ABO-I-LT on six patients. We used anti-CD20 monoclonal antibody combined with plasma exchange preoperatively and intraportal or hepatic-arterial infusion, consisting of prostaglandin E1, corticosteroids, and protease inhibitor postoperatively to prevent AMR. Splenectomy was performed in patients 1, 4, 5 and 6 but not in patients 2 and 3. Weekly liver biopsies were performed after ABO-I-LT. When severe AMR was diagnosed, we performed plasma exchange combined with gamma-globulin bolus infusion (PE+IVIG). In patients 1-3, severe jaundice, rapid decreases in platelet counts, and severe coagulopathy were observed in the early postoperative period. Liver biopsies sampled after the onset of these clinical findings were characterized by severe periportal and lobular hemorrhagic and neutrophil infiltration, suggesting that severe AMR occurred. However, after the initiation of PE+IVIG, AMR was remedied in all three patients. In patients 4-6, severe AMR was not observed. Mild AMR ch...Continue Reading

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Citations

Mar 29, 2016·Journal of the American College of Surgeons·Abbas RanaJohn A Goss
Jan 29, 2014·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Seung Duk LeeSang-Jae Park
Jan 30, 2015·Transplant International : Official Journal of the European Society for Organ Transplantation·Jian ZhouXiaoshun He
Jun 12, 2012·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·F PaternoG B Klintmalm
Nov 21, 2009·Clinical Transplantation·Kazuhisa TakedaHiroshi Shimada
Sep 30, 2016·World Journal of Transplantation·Silke RummlerUtz Settmacher
Mar 12, 2010·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Shin HwangHea-Seon Ha
Dec 25, 2009·Transplant Infectious Disease : an Official Journal of the Transplantation Society·T HoriS Uemoto
Mar 9, 2019·Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology·Surumi ShajahanUma Devi Padma

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