Adult living-donor liver transplantation with ABO-incompatible grafts

Giuliano Testa, Vladimir Vidanovic, Gregorio Chejfec, Antonio Gangemi, Ronak Iqpal, Marian - Porubsky, Thuy Pham, Enrico Benedetti

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND. Liver transplantation using ABO-incompatible grafts is rarely performed because the reported outcome is poorer than with compatible grafts. We report our positive experience with adult-to-adult living-donor liver transplant (LDLT) using ABO-incompatible grafts. METHODS. The immunosuppressive protocol consisted of plasmapheresis/intravenous immunoglobulin infusion before LDLT followed by thymoglobulin induction and splenectomy, maintenance with tacrolimus/cyclosporine (FK/CSA), mycophenolate mofetil, and a rapid steroid taper. Plasmapheresis was planned for up to 3 months after LDLT aiming at maintaining the anti-ABO titers level below 1:16. Liver biopsies were routinely stained for humoral rejection with complement 4d (C4d) and for biliary damage with cytokeratin 7. RESULTS. Between January 2003 and September 2004, five patients, mean age 59 years, received an ABO-incompatible LDLT. Patient and graft survival was 80% at mean follow-up of 43 months (range, 34-54) for the four surviving patients. One patient died 4 months after LDLT. Humoral rejection occurred in one patient whereas acute cellular rejection was diagnosed in four patients. CONCLUSIONS. ABO-incompatible LDLT can be performed with patient and graft survival similar to compatible LDLT. Minimization of immunosuppression is possible, and chronic biliary damage is not the norm. Better tools than complement 4d staining must be researched to diagnose the features of immunologic damage to the graft. If these results will be confirmed in a greater number of patients, ABO-incompatible LDLT may be proposed when ABO-compatible donors are not available or when the ABO-incompatible donor is the better candidate.

Original languageEnglish (US)
Pages (from-to)681-686
Number of pages6
JournalTransplantation
Volume85
Issue number5
DOIs
StatePublished - Mar 2008
Externally publishedYes

Fingerprint

Living Donors
Liver Transplantation
Transplants
Liver
Plasmapheresis
Graft Survival
Tissue Donors
Keratin-7
Mycophenolic Acid
Immunologic Tests
Intravenous Immunoglobulins
Tacrolimus
Splenectomy
Immunosuppressive Agents
Intravenous Infusions
Immunosuppression
Cyclosporine
Steroids
Maintenance
Staining and Labeling

Keywords

  • ABO-incompatible
  • Liver transplantation
  • Living-donor liver transplant

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Testa, G., Vidanovic, V., Chejfec, G., Gangemi, A., Iqpal, R., Porubsky, M. ., ... Benedetti, E. (2008). Adult living-donor liver transplantation with ABO-incompatible grafts. Transplantation, 85(5), 681-686. https://doi.org/10.1097/TP.0b013e3181665172

Adult living-donor liver transplantation with ABO-incompatible grafts. / Testa, Giuliano; Vidanovic, Vladimir; Chejfec, Gregorio; Gangemi, Antonio; Iqpal, Ronak; Porubsky, Marian -; Pham, Thuy; Benedetti, Enrico.

In: Transplantation, Vol. 85, No. 5, 03.2008, p. 681-686.

Research output: Contribution to journalArticle

Testa, G, Vidanovic, V, Chejfec, G, Gangemi, A, Iqpal, R, Porubsky, M, Pham, T & Benedetti, E 2008, 'Adult living-donor liver transplantation with ABO-incompatible grafts', Transplantation, vol. 85, no. 5, pp. 681-686. https://doi.org/10.1097/TP.0b013e3181665172
Testa, Giuliano ; Vidanovic, Vladimir ; Chejfec, Gregorio ; Gangemi, Antonio ; Iqpal, Ronak ; Porubsky, Marian - ; Pham, Thuy ; Benedetti, Enrico. / Adult living-donor liver transplantation with ABO-incompatible grafts. In: Transplantation. 2008 ; Vol. 85, No. 5. pp. 681-686.
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abstract = "BACKGROUND. Liver transplantation using ABO-incompatible grafts is rarely performed because the reported outcome is poorer than with compatible grafts. We report our positive experience with adult-to-adult living-donor liver transplant (LDLT) using ABO-incompatible grafts. METHODS. The immunosuppressive protocol consisted of plasmapheresis/intravenous immunoglobulin infusion before LDLT followed by thymoglobulin induction and splenectomy, maintenance with tacrolimus/cyclosporine (FK/CSA), mycophenolate mofetil, and a rapid steroid taper. Plasmapheresis was planned for up to 3 months after LDLT aiming at maintaining the anti-ABO titers level below 1:16. Liver biopsies were routinely stained for humoral rejection with complement 4d (C4d) and for biliary damage with cytokeratin 7. RESULTS. Between January 2003 and September 2004, five patients, mean age 59 years, received an ABO-incompatible LDLT. Patient and graft survival was 80{\%} at mean follow-up of 43 months (range, 34-54) for the four surviving patients. One patient died 4 months after LDLT. Humoral rejection occurred in one patient whereas acute cellular rejection was diagnosed in four patients. CONCLUSIONS. ABO-incompatible LDLT can be performed with patient and graft survival similar to compatible LDLT. Minimization of immunosuppression is possible, and chronic biliary damage is not the norm. Better tools than complement 4d staining must be researched to diagnose the features of immunologic damage to the graft. If these results will be confirmed in a greater number of patients, ABO-incompatible LDLT may be proposed when ABO-compatible donors are not available or when the ABO-incompatible donor is the better candidate.",
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AU - Vidanovic, Vladimir

AU - Chejfec, Gregorio

AU - Gangemi, Antonio

AU - Iqpal, Ronak

AU - Porubsky, Marian -

AU - Pham, Thuy

AU - Benedetti, Enrico

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N2 - BACKGROUND. Liver transplantation using ABO-incompatible grafts is rarely performed because the reported outcome is poorer than with compatible grafts. We report our positive experience with adult-to-adult living-donor liver transplant (LDLT) using ABO-incompatible grafts. METHODS. The immunosuppressive protocol consisted of plasmapheresis/intravenous immunoglobulin infusion before LDLT followed by thymoglobulin induction and splenectomy, maintenance with tacrolimus/cyclosporine (FK/CSA), mycophenolate mofetil, and a rapid steroid taper. Plasmapheresis was planned for up to 3 months after LDLT aiming at maintaining the anti-ABO titers level below 1:16. Liver biopsies were routinely stained for humoral rejection with complement 4d (C4d) and for biliary damage with cytokeratin 7. RESULTS. Between January 2003 and September 2004, five patients, mean age 59 years, received an ABO-incompatible LDLT. Patient and graft survival was 80% at mean follow-up of 43 months (range, 34-54) for the four surviving patients. One patient died 4 months after LDLT. Humoral rejection occurred in one patient whereas acute cellular rejection was diagnosed in four patients. CONCLUSIONS. ABO-incompatible LDLT can be performed with patient and graft survival similar to compatible LDLT. Minimization of immunosuppression is possible, and chronic biliary damage is not the norm. Better tools than complement 4d staining must be researched to diagnose the features of immunologic damage to the graft. If these results will be confirmed in a greater number of patients, ABO-incompatible LDLT may be proposed when ABO-compatible donors are not available or when the ABO-incompatible donor is the better candidate.

AB - BACKGROUND. Liver transplantation using ABO-incompatible grafts is rarely performed because the reported outcome is poorer than with compatible grafts. We report our positive experience with adult-to-adult living-donor liver transplant (LDLT) using ABO-incompatible grafts. METHODS. The immunosuppressive protocol consisted of plasmapheresis/intravenous immunoglobulin infusion before LDLT followed by thymoglobulin induction and splenectomy, maintenance with tacrolimus/cyclosporine (FK/CSA), mycophenolate mofetil, and a rapid steroid taper. Plasmapheresis was planned for up to 3 months after LDLT aiming at maintaining the anti-ABO titers level below 1:16. Liver biopsies were routinely stained for humoral rejection with complement 4d (C4d) and for biliary damage with cytokeratin 7. RESULTS. Between January 2003 and September 2004, five patients, mean age 59 years, received an ABO-incompatible LDLT. Patient and graft survival was 80% at mean follow-up of 43 months (range, 34-54) for the four surviving patients. One patient died 4 months after LDLT. Humoral rejection occurred in one patient whereas acute cellular rejection was diagnosed in four patients. CONCLUSIONS. ABO-incompatible LDLT can be performed with patient and graft survival similar to compatible LDLT. Minimization of immunosuppression is possible, and chronic biliary damage is not the norm. Better tools than complement 4d staining must be researched to diagnose the features of immunologic damage to the graft. If these results will be confirmed in a greater number of patients, ABO-incompatible LDLT may be proposed when ABO-compatible donors are not available or when the ABO-incompatible donor is the better candidate.

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