scholarly journals Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation

2021 ◽  
Vol 11 (12) ◽  
pp. 1300
Author(s):  
Wei-Chen Lee ◽  
Chen-Fang Lee ◽  
Tsung-Han Wu ◽  
Hao-Chien Hung ◽  
Jin-Chiao Lee ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Graft Loss ◽  
Initial Assessment ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection ◽  
Group A ◽  
Group B

ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) can be performed successfully. However, anti-ABO isoagglutinin rebound may cause antibody-mediated rejection (AMR) and graft loss. The risk threshold of isoagglutinin rebound is still not defined. 76 ABO-I LDLT recipients were divided into group A (n = 56) with low isoagglutinin titers (<1:256), and group B (n = 20) with high isoagglutinin titers (≥1:256), at initial assessment for liver transplantation. The last 12 patients in group B received a modified desensitization regimen by adding bortezomib to deplete plasma cells. Six (10.7%) patients in group A and 10 (50.0%) patients in group B had postoperative isoagglutinin rebound (p < 0.001). Three patients (5.54%) in group A and two patients (10%) in group B developed clinical AMR (p = 0.602). The cutoff value of postoperative isoagglutinin rebound to cause clinical AMR was ≥1:1024. Among the 12 patients in group B with bortezomib administration, isoagglutinin rebounded up to 1:128 only, and no clinical AMR occurred. In conclusion, the patients with high isoagglutinin titers had a higher rate of postoperative isoagglutinin rebound. Isoagglutinin rebound ≥1:1024 is risky for developing clinical AMR. Adding bortezomib into the desensitization regimen may mitigate isoagglutinin rebound, and avoid clinical AMR.

scholarly journals A Comparative Study of Residual Volume in Donors for Living Donor Liver Transplantation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N M D Asaad ◽  
H Z Shaker ◽  
H S Abdelbaset ◽  
M A Abdelhamid
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Liver Enzymes ◽  
Residual Volume ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Group A ◽  
Group B

Abstract Introduction Living donor liver transplantation (LDLT) was introduced in 1989 to overcome the severe shortage of size-matched DD organs for pediatric recipients. Given the increasing shortage of DD grafts for adults in North America and Europe, living donation (LD) was now being explored as a potential solution to the shortage of DD organs for adults also. Aim This study aims at the exploration of this last point. Whether or not minimizing the residual volume in donors after LDLT affects donors’ morbidity. Concentration will be on postoperative donors’ bilirubin level, liver transaminases pattern and complications according to Clavien’s scale. Patients and Methods It is a Comparative Retrospective Observational Cohort study included 44 liver donors operated upon in Ain Shams Specialized Hospital Liver Transplantation Unit and in Egypt Air Liver Transplantation Unit from January 2014 to April 2017. Results There was no significant difference between two groups regards age, gender, fibrosis, steatosis, operation center, postoperative bilirubin (After how many days it returned to normal, maximum and mean postoperative bilirubin), postoperative complications (didn’t pass grade 2 in group A and grade 3 in group B), liver enzymes (postoperative AST and ALT) and Hospital stay, There were no difference between the two groups in the follow up except for elevation of liver enzymes that didn’t return to normal for more than 15 days in donor 9 and elevation of bilirubin in donors 3, 4 and 10 in group (A) and in donors 13, 24, 25, 26, 32, 33 and 43 in group (B). Conclusion It is concluded that donors with low RVs “not less than 33%” could be chosen and operated upon with no significant complications postoperatively that could affect donors’ safety, We suggest that regular follow up of donors is recommended for 5 years. Also more research regarding RV, donors’ safety, selection and complications is recommended as Egypt is the first country in liver disease worldwide.

scholarly journals Is ABO-Incompatible Living Donor Liver Transplantation Really a Good Alternative for Pediatric Recipients?

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 600
Author(s):  
Catherine de Magnée ◽  
Louise Brunée ◽  
Roberto Tambucci ◽  
Aurore Pire ◽  
Isabelle Scheers ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Humoral Rejection ◽  
Donor Liver ◽  
Retrospective Case ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection

Background: ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been proposed to compensate for donor shortage. To date, few studies have reported detailed ABOi LDLT results in large series of pediatric patients. C4d complement deposition in graft capillaries has been reported to be associated with antibody-mediated rejection in solid organ transplantation. Methods: A retrospective case–control study was conducted, comparing clinical outcomes of each of 34 consecutive pediatric ABOi LDLT recipients with those of 2 non-ABOi pairs (n = 68), matched according to pre-transplant diagnostic criteria, age, and date of transplantation. In addition, we studied the C4d immunostaining pattern in 22 ABOi and in 36 non-ABOi recipients whose liver biopsy was performed within the first 4 post-transplant weeks for suspected acute rejection. Results: The incidence of biliary complications was higher in ABOi recipients (p < 0.05), as were the incidence of acute humoral rejection (p < 0.01) and the incidence of retransplantation (p < 0.05). All children who required retransplantation were older than 1 year at the time of ABOi LDLT. Positive C4d immunostaining was observed in 13/22 (59%) ABOi recipients versus 3/36 (8.3%) non-ABOi recipients (p < 0.0001). Conclusions: ABOi LDLT is a feasible option for pediatric end-stage liver disease but carries increased risks for the recipient, especially for children older than 1 year, even with a specific preparation protocol. C4d immunostaining may be a hallmark of acute humoral rejection in ABOi liver transplantation.

scholarly journals Bortezomib Against Refractory Antibody-Mediated Rejection After ABO-Incompatible Living-Donor Liver Transplantation

2019 ◽  
Vol 5 (10) ◽  
pp. e491 ◽  
Author(s):  
Tetsuya Tajima ◽  
Koichiro Hata ◽  
Hideaki Okajima ◽  
Momoko Nishikori ◽  
Kentaro Yasuchika ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection

scholarly journals Simultaneous ABO-incompatible living-donor liver transplantation and splenectomy without plasma exchange in China: Two case reports

2017 ◽  
Vol 45 (6) ◽  
pp. 2146-2152 ◽  
Author(s):  
Guoyong Chen ◽  
Janjun Sun ◽  
Sidong Wei ◽  
Yongfeng Chen ◽  
Gaofeng Tang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Case Reports ◽  
Graft Function ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection ◽  
First Case ◽  
Life Saving

ABO-incompatible (ABO-i) living-donor liver transplantation (LDLT) is performed if an ABO-compatible graft cannot be obtained. However, a perfect desensitization protocol has not been established worldwide, especially for simultaneous ABO-i LDLT and splenectomy. We herein report two cases of ABO-i LDLT. To the best of our knowledge, this is the first case report of ABO-i LDLT in an adult patient in China. Splenectomy and T-cell-targeted immunosuppression (basiliximab) was used to overcome the blood group barrier in these recipients. The patients had good graft function without signs of antibody-mediated rejection throughout the 12-month follow-up. Thus, ABO-i LDLT with splenectomy is undoubtedly life-saving when an ABO-compatible graft cannot be obtained for patients in critical condition.

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