Korean J Transplant.  2020 Jun;34(2):109-113. 10.4285/kjt.2020.34.2.109.

Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients

• Lee B
• Cho JY
• Lee HW
• Choi Y
• Yoon YS
• Han HS

• KMID: 2503887
• DOI: http://doi.org/10.4285/kjt.2020.34.2.109

Abstract

The role of the isoagglutinin (IA) titer in liver transplantation (LT) is still not well defined, but the general belief is that a higher titer may result in a higher risk of rejection in ABO-incompatible living donor LT. To reduce the IA titer by 1:16 or lower, plasmapheresis is usually performed before transplantation. However, there is no established protocol for patients for whom plasmapheresis has failed before reaching the target IA titers. Here, we report the cases of three patients who show high baseline IA titers and have failed plasmapheresis: no-response to plasmapheresis, allergic reaction associated with plasmapheresis, and anaphylactic reaction to platelet transfusion. For various reasons, after several plasmapheresis procedures, IA titers were not effectively reduced. In these patients, splenectomy and intravenous immunoglobulin (0.8 g/kg, from the anhepatic phase to 2 days after transplantation) were carried. The protocol biopsy on postoperative day 7 showed no histologic evidence of meaningful acute rejection. The main aim of this work is to demonstrate that we can apply this protocol to patients who have high baseline IA titers and have failed plasmapheresis. Furthermore, this report is enhanced to promote to the transplant community this approach with this type of recipient.

Keyword

Liver transplantation; Plasmapheresis; Graft rejection; Splenectomy; Immunoglobulins, intravenous

Figure

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  Fig. 1 Desensitization protocol for ABO incompatible (ABOi) living donor liver transplantation. LDLT, living donor liver transplantation; MMF, mycophenolate mofetil; IA, isoagglutinin; PP, plasmapheresis.

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  Fig. 2 Desensitization protocol for patients who have failed plasmapheresis. LDLT, living donor liver transplantation; MMF, mycophenolate mofetil; IA, isoagglutinin; PP, plasmapheresis; IVIg, intravenous immunoglobulin; LT, liver transplantation; ABOi, ABO incompatible.

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