ABO-Incompatible Living Donor Liver Transplantation in Focus of Antibody Rebound

• Published in: Transfusion medicine and hemotherapy Vol. 44; no. 1; pp. 46 - 51
• Main Authors: Rummler, Silke, Bauschke, Astrid, Baerthel, Erik, Juette, Heike, Maier, Katrin, Malessa, Christina, Barz, Dagmar, Settmacher, Utz
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger GmbH 01.01.2017
• Subjects: Original; Original Article; Transplantation; ABO incompatibility; Liver; Antibody rebound
• ISSN: 1660-3796; 1660-3818
• DOI: 10.1159/000450792

Background: Living donor liver transplantation (LDLT) is an option to expand the donor organ pool for patients with life-threatening diseases who cannot be supplied with a cadaver organ. Next to the donor risks, complications after ABO-incompatible LDLT (ABOi LDLT) in the recipient are subject to controversial discussion. Improvement in ABOi graft survival rates have been achieved with plasma treatment procedures (PTP) and immunosuppression but antibody-mediated rejection (AMR) and graft loss still occur. Methods: Since 2008, we have prepared 10 patients for ABOi LDLT. Seven of the 10 patients for transplantation had hepatocellular carcinoma (HCC). Results: All patients underwent PTP before and after ABOi LDLT as well as immunosuppression according to the treatment schedule. We did not use anti-CD20 monoclonal antibodies in the transplant setting. We transplanted 6 of 10 preconditioned patients. After 3 years, 5 of the 6 transplanted patients were still alive. Conclusion: Even if B-cell depletion with anti-CD 20 treatment in the setting of ABOi LDLT is commonly accepted, our center successfully administered only quadruple drug immunosuppression combined with PTP. Especially patients with HCC had a high titer increment also pre-transplantation and were at high risk for arterial thrombosis and graft loss.