J Korean Soc Transplant.  2015 Mar;29(1):28-32. 10.4285/jkstn.2015.29.1.28.

Living-donor Sequential ABO-incompatible Kidney Transplantation after Liver Transplantation in a Patient with Alcoholic Liver Cirrhosis and End-stage Renal Disease

• Kwak JH
• Jang HJ
• Choi GM
• Park CS
• Eom DW
• Kim SS
• Han DJ
• Kim IK

• KMID: 2202561
• DOI: http://doi.org/10.4285/jkstn.2015.29.1.28

Abstract

A 47-year-old man developed chronic alcoholic liver cirrhosis and end-stage renal disease. He underwent blood-type-compatible liver transplantation with a graft from his daughter. After 8 months, sequential ABO-incompatible (ABOi) kidney transplantation was performed, with his brother as the donor (A to O). The patient had anti-A antibody titers (1:256). We performed pretransplant desensitization, including administration of rituximab, mycophenolate mofetil, tacrolimus, and prednisolone 2 weeks before the scheduled transplantation, and plasmaphresis (PP) and administered an intravenous immunoglobulin injection. The patient underwent PP before kidney transplantation until the anti-A antibody titer was <1:8. The patient achieved normal renal function within 4 posttransplantation days. Postoperative bleeding (diffuse hemorrhage) requiring additional blood transfusions and radiological intervention (drainage procedure) occurred 9 days after transplantation. The patient was discharged on day 20 of hospitalization. Nine months after the kidney transplantation, the recipient's and donor's liver and kidney functions were normal. ABOi renal transplantation after liver transplantation can be successfully performed in patients with high baseline anti-ABO antibody titers after preconditioning with rituximab and PP, and quadruple immunosuppressive therapy. However, caution is required regarding an increased risk of bleeding complications.

Keyword

Sequential ABO-incompatible kidney transplantation; Liver transplantation; Bleeding complication

MeSH Terms

Blood Transfusion
Hemorrhage
Hospitalization
Humans
Immunoglobulins
Kidney
Kidney Failure, Chronic*
Kidney Transplantation*
Liver
Liver Cirrhosis, Alcoholic*
Liver Transplantation*
Middle Aged
Nuclear Family
Prednisolone
Rituximab
Siblings
Tacrolimus
Tissue Donors
Transplants
Immunoglobulins
Prednisolone
Tacrolimus

Figure

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  Fig. 1. (A) Hemoglobin, (B) hematocrit, (C) platelete, and (D) creatinine levels after kidney transplantation.

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  Fig. 2. Computed tomographic images showing a perinephric hematoma. An approximately 8×9 cm phlegmonous change with an approximate 5×2 cm fluid collection seen in the right side of the transplanted kidney.

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  Fig. 3. (A) Plain film showing pigtail drainage in the hematoma location. (B) Computed tomographic image showing the improvement after the drainage procedure: decreased fluid collection around the transplanted kidney in the right iliac fossa.

Reference

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