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
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)).
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).
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.
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