Seroconversion of red blood cell antibody in ABO-incompatible living donor liver transplantation -a case report

• Published in: Korean journal of anesthesiology Vol. 73; no. 3; pp. 252 - 256
• Main Authors: Lee, Eun Kyung, Song, Insun, Kim, Gaab Soo
• Format: Journal Article
• Language: English
• Published: Korean Society of Anesthesiologists 01.06.2020; 대한마취통증의학회
• Subjects: Case Report; erythrocytes; liver transplantation; plasmapheresis; red blood cell antibody screen test; rituximab; 마취과학
• ISSN: 2005-6419; 2005-7563; 2005-7563
• DOI: 10.4097/kja.19141

Liver transplantation usually requires blood transfusion, and a red blood cell (RBC) antibody screen is essential for the prevention of a hemolytic reaction. Since proper ABO-compatible grafts are lacking, ABO-incompatible living donor liver transplantation (ABO-i LDLT) with desensitization is a feasible therapy. Desensitization includes intravenous rituximab injection and plasmapheresis before surgery.BACKGROUNDLiver transplantation usually requires blood transfusion, and a red blood cell (RBC) antibody screen is essential for the prevention of a hemolytic reaction. Since proper ABO-compatible grafts are lacking, ABO-incompatible living donor liver transplantation (ABO-i LDLT) with desensitization is a feasible therapy. Desensitization includes intravenous rituximab injection and plasmapheresis before surgery.A 60-year-old female was diagnosed with hepatitis B virus-related hepatocellular carcinoma and planned for ABO-i LDLT. She tested positive in a RBC antibody screen over two years; however, she tested negative for the test after desensitization. Clinicians noted the seroconversion during induction, and thus, a delay in the preparation of adequate packed RBC was unavoidable.CASEA 60-year-old female was diagnosed with hepatitis B virus-related hepatocellular carcinoma and planned for ABO-i LDLT. She tested positive in a RBC antibody screen over two years; however, she tested negative for the test after desensitization. Clinicians noted the seroconversion during induction, and thus, a delay in the preparation of adequate packed RBC was unavoidable.Even when the latest RBC antibody screen is negative after immunosuppression, clinicians should consider the possibility of a prior positive result to promote safer medical treatment and management.CONCLUSIONSEven when the latest RBC antibody screen is negative after immunosuppression, clinicians should consider the possibility of a prior positive result to promote safer medical treatment and management.