Deceased Non-A2 Donor ABO-Incompatible Liver Transplantation – Promising Results with Anti-A/B Antibody Reduction Both Pre- and Post-Transplant.
1Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
2Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
3Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
4Department of Nephrology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Meeting: 2016 American Transplant Congress
Abstract number: D175
Keywords: Allocation, Immunoadsorption, Outcome
Session Information
Date: Tuesday, June 14, 2016
Session Name: Poster Session D: Liver: Immunosuppression and Rejection
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Introduction
One way to expand the donor pool for patients with acute liver failure could be to use deceased donor (DD) ABO-incompatible (ABOi) liver grafts. However, previous reports of DD ABOi liver transplantation (LT) have shown a significantly increased risk for rejection, vascular and biliary complications caused by preformed anti-A/B antibodies. Here we report our experience with an antibody depleting protocol for non-A2 DD ABOi LT.
Patients and Methods
Between 2010-2015 we performed nine non-A2 DD ABOi LT. The immunosuppressive protocol consisted of induction with Rituximab (single dose day 0, 375mg/m2) and Basiliximab (20 mg day 0 and 4), Tacrolimus, Prednisolone and Mycophenolate Mofetil. Antigen specific immunoadsorptions (IA, Glycosorb®,Glycorex AB Sweden) were performed before (n=8) and/or after transplantation (n=6). Eight recipients were adult and one paediatric. Median MELD score was 24 (range 10-40). The PELD score for the paediatric recipient was 21. The blood group combinations (donor-recipient) were A1-O (n=6), B-O (n=1), AB-A (n=1) and AB-B (n=1). The indications were acute/subacute liver failure (n=5), non-urgent causes (n=4) (hepatocellular carcinoma and prolonged waiting list time (n=1), alcohol (n=2), autoimmune hepatits (n=1)).
Results
The patient and graft survival so far is 78% with a median follow-up of 32 months (range 7d-68m). Two patients/grafts were lost due to non ABOi-related causes. There were no humoral rejections and no vascular or biliary complications. The median pre-transplant anti-A/B antibody titers for IgM was 4 (range 1-8) and for IgG 8 (range 2-32). The median maximum post-transplant anti-A/B titer for IgM was 2 (range 0-8) and for IgG 8 (range 2-32).
Conclusion
In this small cohort of non-A2 DD ABOi LT, our protocol with pre-, and post-LT anti-A/B antibody depletion seems very promising. So far we have not had any episodes of humoral rejection nor vascular or biliary complications.
CITATION INFORMATION: Dahlgren U, Herlenius G, Mölne J, Rydberg L, Samuelsson O, Bennet W. Deceased Non-A2 Donor ABO-Incompatible Liver Transplantation – Promising Results with Anti-A/B Antibody Reduction Both Pre- and Post-Transplant. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Dahlgren U, Herlenius G, Mölne J, Rydberg L, Samuelsson O, Bennet W. Deceased Non-A2 Donor ABO-Incompatible Liver Transplantation – Promising Results with Anti-A/B Antibody Reduction Both Pre- and Post-Transplant. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/deceased-non-a2-donor-abo-incompatible-liver-transplantation-promising-results-with-anti-ab-antibody-reduction-both-pre-and-post-transplant/. Accessed August 7, 2020.« Back to 2016 American Transplant Congress