Background

ABO incompatible (ABOi) living donor liver transplantation (LDLT) has become a feasible option for patients with end-stage liver disease due to development of various desensitization strategies. However, there has been no united desensitization protocol for ABOi LDLT. We have established a simplified protocol that does not incorporate splenectomy or local infusion therapy and analyzed the outcomes in a single-center clinical study.

Methods

We analyzed 19 ABOi LDLT cases that had been performed without concurrent splenectomy and local infusion between January 2012 and December 2013. We used a single dose of rituximab (375mg/m2) 10 days before transplantation and several series of plasma exchange to adjust the patients' isoagglutinin titer to a target titer of 1:32.

Results

The mean initial immunoglobulin (Ig) M and IgG anti-ABO titers were 76.63 ± 78.81 (range 8∼256) and 162.53 ± 464.1 (0∼2048) respectively. We performed preoperative plasma exchange on 16 patients and postoperative plasma exchange on nine patients. One case of mortality occurred due to pneumonia. There were four cases (21.1%) of acute rejection, all of which were treated successfully with steroid pulse or antithymocyte globulin. Antibody-mediated rejection or graft failure did not occur. A total of six postoperative complications occurred, including three infections (15.8%), two cases of anastomotic biliary stricture (10.5%), and one case of portal vein stenosis (5.3%).

Conclusion

ABOi LDLT following a simplified protocol can be safely performed without an increased risk of antibody-mediated rejection or other complications compared to other ABOi LDLT protocols.

Simplified desensitization protocol for ABO incompatible living donor liver transplantation

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