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

• Lee SH
• Choi HJ
• You YK
• Kim DG
• Na GH

• KMID: 2430588
• DOI: http://doi.org/10.4285/jkstn.2018.32.4.84

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

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  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.

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