Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia |
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Authors: | Yamada Yohei Hoshino Ken Morikawa Yasuhide Okamura Jun Hotta Ryo Komori Koji Nakao Shioko Obara Hideaki Kawachi Shigeyuki Fuchimoto Yasushi Tanabe Minoru Shimazu Motohide Kitajima Masaki |
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Affiliation: | Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo 160-8582, Japan |
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Abstract: | BackgroundThe problem of ABO-incompatible liver transplantation still remains unsolved in older children. In this article, we report on our experience of 6 successful ABO-incompatible liver transplantations in patients with biliary atresia.Material and MethodsSix patients (ABO incompatibility type A→O:1 case, B→O:2 cases, A→B:3 cases) were enrolled in this study; 3 patients were aged approximately 1 year and the other 3 ranged in age from 9 to 24 years at the time of transplantation. Each patient received perioperative plasma exchange, until the anti-donor blood-type antibody titers became less than 1:16, and also systemic multidrug immunosuppressive therapy (cyclophosphamide, prednisolone, and tacrolimus). We applied the protocol of intraportal infusion therapy (local administration of prostaglandin E1, steroid, and gabexate mesilate via a portal vein catheter), splenectomy, and rituximab administration for the older group.ResultsBoth the patient and graft survival rates remain at 100%, with the follow-up period of the patients ranging from 12 and 123 months. Acute cellular rejection occurred in 2 cases, and both were steroid sensitive. There was no incidence of humoral rejection. Although all cases developed viral infection, all recovered uneventfully with the administration of antiviral agents.ConclusionABO-incompatible liver transplantation can be performed with a low risk of humoral rejection or late biliary complications using this combined antirejection strategy, even in older children. |
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Keywords: | ABO incompatible liver transplantation Intraportal infusion therapy Humoral rejection Children |
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