ABOIncompatible Liver Transplantation: A Single Center Experience_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHAO Yongheng , LI Li , RAN Jianghua , LI Laibang , LI Zhu , LIU Jing , JIANG Yizhou , WU Shuyuan , LIANGYu , LIU Diansheng.

Department of Liver, Biliary and Pancreatic Surgery, The First People’s Hospital of Kunming City, Kunming 650011, Yunnan Province, China;

Corresponding author：

Keywords：

Liver transplantation; ABO-incompatible; Splenectomy; Immunosuppression

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ObjectiveTo explore perioperative management model of ABO-incompatible liver transplantation. MethodsThe clinical data of ABO-incompatible caderveric liver transplantions without urgency performed in our center from July 2006 to May 2010 were analyzed retrospectively. Four patients had received an ABO-incompatible graft: AB to O in three, AB to A in one. All the cases were diagnosed as end-stage liver disese, one of them was primary hepatocellular carcinoma. ResultsFour survived to now （11 to 19 months） without severe infections and acute rejections. Two experienced coagulative disturbance and one of them had a second exploration. One developed acute renal failure and recovered with help under continuous veno-venous hemofiltration. All the cases were given 20 mg basiliximab two hours before revascularization and on day 4 after operation respectively. Splenectomy was performed in three, intravenous immunoglobulin was given in all more than seven days. Isohemagglutinin titers were basically stable and not relevant to the clinical manifestations. Antibiotic prophylaxis and immunosuppression protocol was same as the ABO compatible transplants except a 3-month-delay for steroid withdrawal. ConclusionABO-incompatible liver transplantation could be performed with appropriate perioperative management, such as basiliximab induction, splenectomy, intravenous immunoglobulin administration, and routine immunosuppression.

Citation： ZHAO Yongheng,LI Li,RAN Jianghua,LI Laibang,LI Zhu,LIU Jing,JIANG Yizhou,WU Shuyuan,LIANGYu,LIU Diansheng.. ABOIncompatible Liver Transplantation: A Single Center Experience. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(6): 595-598. doi: Copy

1.	Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J]. Transplantation, 2003, 75(3): 347353.
2.	SanchezUrdazpal L, Batts KP, Gores GJ, et al. Increased bile duct complications in liver transplantation across the ABO barrier [J]. Ann Surg, 1993, 218(2): 152158.
3.	Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [J]. Lancet, 1990, 336(8714): 519523.
4.	Hanto DW, Fecteau AH, Alonso MH, et al. ABOincompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation [J]. Liver Transpl, 2003, 9(1): 2230.
5.	Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J].Transplantation, 2003, 75(3): 347353.
6.	Stewart ZA, Locke JE, Montgomery RA, et al. ABOincompatible deceased donor liver transplantation in the United States: a national registry analysis [J]. Liver Transpl, 2009, 15(8): 883893.
7.	Toso C, AlQahtani M, Alsaif FA, et al. ABOincompatible liver transplantation for critically ill adult patients [J]. Transpl Int, 2007, 20(8): 675681.
8.	Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier [J]. Transplantation, 1994, 58(5): 543547.
9.	Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABOincompatible livingdonor liver transplantation [J]. Transplantation, 2004, 77(3): 403411.
10.	VarelaFascinetto G, Treacy SJ, Lillehei CW, et al. Longterm results in pediatric ABOincompatible liver transplantation [J]. Transplant Proc, 1999, 31(12): 467468.
11.	Wu J, Ye S, Xu X, et al. Recipient outcomes after ABOincompatible liver transplantation: a systematic review and metaanalysis [J]. PLoS One, 2011, 6(1): e16521.
12.	Shimmura H, Tanabe K, Ishikawa N, et al. Role of antiA/B antibody titers in results of ABOincompatible kidney transplantation [J]. Transplantation, 2000, 70(9): 13311335.
13.	Ishikawa N, Yagisawa T, Sakuma Y, et al. Transplantation of ABOincompatible and living unrelated donorrecipient combinations [J]. Transplant Proc, 2008, 40(7): 22922293.
14.	Ashizawa T, Matsuno N, Yokoyama T, et al. The role of plasmapheresis therapy for perioperative management in ABOincompatible adult living donor liver transplantation [J]. Transplant Proc, 2006, 38(10): 36293632.
15.	Saliba F, Icha P, Azoulay D, et al. Successful longterm outcome of ABOincompatible liver transplantation using antigenspecific immunoadsorption columns [J]. Ther Apher Dial, 2010, 14(1): 116123.
16.	Kim BW, Park YK, Kim YB, et al. Effects and problems of adult ABOincompatible living donor liver transplantation using protocol of plasma exchange, intraarterial infusion therapy, and antiCD20 monoclonal antibody without splenectomy: case reports of initial experiences and results in Korea [J]. Transplant Proc, 2008, 40(10): 37723777.
17.	Ishida H, Koyama I, Sawada T, et al. AntiAB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation [J]. Transplantation, 2000, 70(4): 681685.
18.	Shimazu M, Kitajima M. Living donor liver transplantation with special reference to ABOincompatible grafts and smallforsize grafts [J]. World J Surg, 2004, 28(1): 27.
19.	公伟, 列军, 杨凤辉, 等. ABO血型不合的肝移植(附3例报道 [J]. 中国普外基础与临床杂志, 2009, 16(3): 187190.
20.	梁廷波, 汤晓锋, 王伟林, 等. 肝移植中应用血型不合供肝的初步经验 [J]. 中华普通外科杂志, 2006, 21(6): 399402.
21.	Tanabe M, Shimazu M, Wakabayashi G, et al. Intraportal infusion therapy as a novel approach to adult ABOincompatible liver transplantation [J]. Transplantation, 2002, 73(12): 19591961.
22.	Nakamura Y, Matsuno N, Iwamoto H, et al. Successful case of adult ABOincompatible liver transplantation: beneficial effects of intrahepatic artery infusion therapy: a case report [J]. Transplant Proc, 2004, 36(8): 22692273.
23.	刘其雨, 李立, 李晓延. ABO血型不合肝移植的研究进展 [J]. 中国普外基础与临床杂志, 2009, 16(3): 195198.

1. Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J]. Transplantation, 2003, 75(3): 347353.
2. SanchezUrdazpal L, Batts KP, Gores GJ, et al. Increased bile duct complications in liver transplantation across the ABO barrier [J]. Ann Surg, 1993, 218(2): 152158.
3. Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [J]. Lancet, 1990, 336(8714): 519523.
4. Hanto DW, Fecteau AH, Alonso MH, et al. ABOincompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation [J]. Liver Transpl, 2003, 9(1): 2230.
5. Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J].Transplantation, 2003, 75(3): 347353.
6. Stewart ZA, Locke JE, Montgomery RA, et al. ABOincompatible deceased donor liver transplantation in the United States: a national registry analysis [J]. Liver Transpl, 2009, 15(8): 883893.
7. Toso C, AlQahtani M, Alsaif FA, et al. ABOincompatible liver transplantation for critically ill adult patients [J]. Transpl Int, 2007, 20(8): 675681.
8. Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier [J]. Transplantation, 1994, 58(5): 543547.
9. Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABOincompatible livingdonor liver transplantation [J]. Transplantation, 2004, 77(3): 403411.
10. VarelaFascinetto G, Treacy SJ, Lillehei CW, et al. Longterm results in pediatric ABOincompatible liver transplantation [J]. Transplant Proc, 1999, 31(12): 467468.
11. Wu J, Ye S, Xu X, et al. Recipient outcomes after ABOincompatible liver transplantation: a systematic review and metaanalysis [J]. PLoS One, 2011, 6(1): e16521.
12. Shimmura H, Tanabe K, Ishikawa N, et al. Role of antiA/B antibody titers in results of ABOincompatible kidney transplantation [J]. Transplantation, 2000, 70(9): 13311335.
13. Ishikawa N, Yagisawa T, Sakuma Y, et al. Transplantation of ABOincompatible and living unrelated donorrecipient combinations [J]. Transplant Proc, 2008, 40(7): 22922293.
14. Ashizawa T, Matsuno N, Yokoyama T, et al. The role of plasmapheresis therapy for perioperative management in ABOincompatible adult living donor liver transplantation [J]. Transplant Proc, 2006, 38(10): 36293632.
15. Saliba F, Icha P, Azoulay D, et al. Successful longterm outcome of ABOincompatible liver transplantation using antigenspecific immunoadsorption columns [J]. Ther Apher Dial, 2010, 14(1): 116123.
16. Kim BW, Park YK, Kim YB, et al. Effects and problems of adult ABOincompatible living donor liver transplantation using protocol of plasma exchange, intraarterial infusion therapy, and antiCD20 monoclonal antibody without splenectomy: case reports of initial experiences and results in Korea [J]. Transplant Proc, 2008, 40(10): 37723777.
17. Ishida H, Koyama I, Sawada T, et al. AntiAB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation [J]. Transplantation, 2000, 70(4): 681685.
18. Shimazu M, Kitajima M. Living donor liver transplantation with special reference to ABOincompatible grafts and smallforsize grafts [J]. World J Surg, 2004, 28(1): 27.
19. 公伟, 列军, 杨凤辉, 等. ABO血型不合的肝移植(附3例报道 [J]. 中国普外基础与临床杂志, 2009, 16(3): 187190.
20. 梁廷波, 汤晓锋, 王伟林, 等. 肝移植中应用血型不合供肝的初步经验 [J]. 中华普通外科杂志, 2006, 21(6): 399402.
21. Tanabe M, Shimazu M, Wakabayashi G, et al. Intraportal infusion therapy as a novel approach to adult ABOincompatible liver transplantation [J]. Transplantation, 2002, 73(12): 19591961.
22. Nakamura Y, Matsuno N, Iwamoto H, et al. Successful case of adult ABOincompatible liver transplantation: beneficial effects of intrahepatic artery infusion therapy: a case report [J]. Transplant Proc, 2004, 36(8): 22692273.
23. 刘其雨, 李立, 李晓延. ABO血型不合肝移植的研究进展 [J]. 中国普外基础与临床杂志, 2009, 16(3): 195198.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

ABOIncompatible Liver Transplantation: A Single Center Experience

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