J Korean Soc Transplant.  2018 Dec;32(4):84-91. 10.4285/jkstn.2018.32.4.84.

ABO Incompatible Living Donor Liver Transplantation: A Single Center Experience

Affiliations
  • 1Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea. nagh0214@naver.com
  • 2Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

BACKGROUND
This study examined the outcomes of ABO incompatible living donor liver transplantation (LDLT). The changes in the immunologic factors that might help predict the long term outcomes were also studied.
METHODS
Twenty-three patients, who underwent ABO incompatible LDLT from 2010 to 2015, were reviewed retrospectively. The protocol was the same as for ABO compatible LDLT except for the administration of rituximab and plasma exchange. The clinical outcomes and immunologic factors, such as isoagglutinin titer and cluster of differentiation 20+ (CD20+) lymphocyte levels were reviewed.
RESULTS
The center showed a 3-year survival of 64% with no case of antibody-mediated rejection. When transplantation-unrelated mortalities (for example, traffic accidents and myocardial infarction) were removed from statistical analysis, the 3-year survival was 77.8%. Although isoagglutinin titers continued to remain at low levels, the CD20+ lymphocyte levels recovered to the pre-Rituximab levels at postoperative one year.
CONCLUSIONS
As donor shortages continue, ABO incompatible liver transplantation is a feasible method to expand the donor pool. On the other hand, caution is still needed until more long-term outcomes are reported. Because CD20+ lymphocytes are recovered with time, more immunologic studies will be needed in the future.

Keyword

ABO blood-group system; B-lymphocytes; Hemagglutinins; Liver transplantation; Survival

MeSH Terms

ABO Blood-Group System
Accidents, Traffic
B-Lymphocytes
Hand
Hemagglutinins
Humans
Immunologic Factors
Liver Transplantation*
Liver*
Living Donors*
Lymphocytes
Methods
Mortality
Plasma Exchange
Retrospective Studies
Rituximab
Tissue Donors
ABO Blood-Group System
Hemagglutinins
Immunologic Factors
Rituximab

Figure

  • Fig. 1 Change of isoagglutinin titer in ABO incompatible living donor liver transplantation. (A) Immunoglobulin M (IgM) isoagglutinin titer, (B) immunoglobulin G (IgG) isoagglutinin titer. Abbreviations: Neg, negative; OP, operation.

  • Fig. 2 Change of CD20+ lymphocytes in ABO incompatible living donor liver transplantation. Abbreviation: OP, operation.

  • Fig. 3 Overall survival after ABO incompatible living donor liver transplantation.


Reference

1. Starzl TE, Koep LJ, Halgrimson CG, Hood J, Schroter GP, Porter KA, et al. Fifteen years of clinical liver transplantation. Gastroenterology. 1979; 77:375–388.
Article
2. Gugenheim J, Samuel D, Reynes M, Bismuth H. Liver transplantation across ABO blood group barriers. Lancet. 1990; 336:519–523.
Article
3. Rego J, Prevost F, Rumeau JL, Modesto A, Fourtanier G, Durand D, et al. Hyperacute rejection after ABO-incompatible orthotopic liver transplantation. Transplant Proc. 1987; 19:4589–4590.
4. Monteiro I, McLoughlin LM, Fisher A, de la Torre AN, Koneru B. Rituximab with plasmapheresis and splenectomy in abo-incompatible liver transplantation. Transplantation. 2003; 76:1648–1649.
Article
5. Stewart ZA, Locke JE, Montgomery RA, Singer AL, Cameron AM, Segev DL. ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis. Liver Transpl. 2009; 15:883–893.
Article
6. Kim JD, Choi DL, Kim SG, Lee AJ. Single-center experience of ABO-incompatible living-donor liver transplantation with a new simplified intravenous immunoglobulin protocol: a propensity score-matching analysis. Transplant Proc. 2016; 48:1134–1138.
Article
7. Kim SJ, Na GH, Choi HJ, Yoo YK, Kim DG. Surgical outcome of right liver donors in living donor liver transplantation: single-center experience with 500 cases. J Gastrointest Surg. 2012; 16:1160–1170.
Article
8. Na GH, Kim DG, Choi HJ, Han JH, Hong TH, You YK. Interventional treatment of a biliary stricture after adult right-lobe living-donor liver transplantation with duct-to-duct anastomosis. HPB (Oxford). 2014; 16:312–319.
Article
9. Demetris AJ, Jaffe R, Tzakis A, Ramsey G, Todo S, Belle S, et al. Antibody-mediated rejection of human orthotopic liver allografts. A study of liver transplantation across ABO blood group barriers. Am J Pathol. 1988; 132:489–502.
10. Uchiyama H, Mano Y, Taketomi A, Soejima Y, Yoshizumi T, Ikegami T, et al. Kinetics of anti-blood type isoagglutinin titers and B lymphocytes in ABO-incompatible living donor liver transplantation with rituximab and plasma exchange. Transplantation. 2011; 92:1134–1139.
Article
11. Usuda M, Fujimori K, Koyamada N, Fukumori T, Sekiguchi S, Kawagishi N, et al. Successful use of anti-CD20 monoclonal antibody (rituximab) for ABO-incompatible living-related liver transplantation. Transplantation. 2005; 79:12–16.
Article
12. Song GW, Lee SG, Hwang S, Kim KH, Ahn CS, Moon DB, et al. ABO-incompatible adult living donor liver transplantation under the desensitization protocol with rituximab. Am J Transplant. 2016; 16:157–170.
Article
13. Lee J, Lee JG, Lee JJ, Kim MS, Ju MK, Choi GH, et al. Results of ABO-incompatible liver transplantation using a simplified protocol at a single institution. Transplant Proc. 2015; 47:723–726.
Article
14. Lee SD, Kim SH, Kong SY, Kim YK, Park SJ. Kinetics of B, T, NK lymphocytes and isoagglutinin titers in ABO incompatible living donor liver transplantation using rituximab and basiliximab. Transpl Immunol. 2015; 32:29–34.
Article
15. Kim JM, Kwon CH, Joh JW, Kang ES, Park JB, Lee JH, et al. ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor. J Hepatol. 2013; 59:1215–1222.
Article
16. Lee EC, Kim SH, Shim JR, Park SJ. A comparison of desensitization methods: rituximab with/without plasmapheresis in ABO-incompatible living donor liver transplantation. Hepatobiliary Pancreat Dis Int. 2018; 17:119–125.
Article
17. Raut V, Mori A, Kaido T, Ogura Y, Taku I, Nagai K, et al. Splenectomy does not offer immunological benefits in ABO-incompatible liver transplantation with a preoperative rituximab. Transplantation. 2012; 93:99–105.
Article
18. Ikegami T, Taketomi A, Soejima Y, Yoshizumi T, Uchiyama H, Harada N, et al. Rituximab, IVIG, and plasma exchange without graft local infusion treatment: a new protocol in ABO incompatible living donor liver transplantation. Transplantation. 2009; 88:303–307.
Article
Full Text Links
  • JKSTN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr