First Case Studies of Successful ABO-Incompatible Living-Related Liver Transplantation in Infants in Germany

Abstract

Aim A series study mainly from Asia suggests that ABO-incompatible (ABOi) living-related liver transplantation (LRLT) for pediatric recipients is associated with excellent short- and long-term graft and patient survival. Until now, ABOi LRLT has been rarely performed in Europe. The aim of this study was to analyze the safety and early results of an ABOi LRLT in a German high-volume pediatric liver transplant center.

Methods Six consecutive pediatric patients (four males and two females) were included in this prospective study from January, 2010 to January, 2013 with a median age of 13 months (range, 6–30 months) receiving ABOi LRLT and were matched with six patients receiving ABO-compatible LRLT in the same period. In the ABOi group, titers of IgG and IgM isoagglutinins against the donor's blood group were determined at day 14 before the transplantation and from day 1 to 14 after the transplantation, and then twice a week for another 8 weeks. The titer results were determined as the reciprocal number of the highest serum dilution that caused macroscopical reaction.

Results The patients receiving ABOi and those receiving ABO-compatible LRLT were comparable regarding the recipient's preoperative pediatric end-stage liver disease (PELD), age, gender, and technical aspects of transplantation. The median follow-up was 2.6 years (range, 1–4.5 years). At the time of operation, the mean body weight was 7.7 kg (range, 5.7–16 kg) in ABO-compatible LRLT recipients and 8.8 kg (range, 5.5–18 kg) in ABOi LRLT recipients. In each group, the median PELD score was 28 (range, 28–35), respectively. All recipients received tacrolimus plus mycophenolate mofetil-based standard immunosuppression and four ABOi transplanted patients received intravenous immunoglobulins at days 1, 3, and 5 after liver transplantation. Patient and graft survival in this group was 83%. One female patient died within 24 hours due to fulminant gram-negative sepsis. Another patient developed acute cellular rejection at the 8th postoperative day, which responded to steroid treatment. No further complications occurred. In the ABO-compatible group, patient survival was 100% and graft survival was 83%; one patient in this group received retransplantation after 4 days. During follow-up, two patients of the ABOi group had maximum alloantibody titers of four against the donor's blood group; all other patients had titers below four.

Conclusion ABOi LRLT seems to be safe without an escalation of immunosuppression and should be considered as an additional option to timely facilitate the transplantation.

Keywords

living donor - blood group - immunoglobulin - alloantibody - liver transplant

• References

• 1 Tanabe M, Kawachi S, Obara H , et al. Current progress in ABO-incompatible liver transplantation. Eur J Clin Invest 2010; 40 (10) 943-949
• 2 Heffron T, Welch D, Pillen T , et al. Successful ABO-incompatible pediatric liver transplantation utilizing standard immunosuppression with selective postoperative plasmapheresis. Liver Transpl 2006; 12 (6) 972-978
• 3 Raut V, Uemoto S. Management of ABO-incompatible living-donor liver transplantation: past and present trends. Surg Today 2011; 41 (3) 317-322
• 4 Stewart ZA, Locke JE, Montgomery RA, Singer AL, Cameron AM, Segev DL. ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis. Liver Transpl 2009; 15 (8) 883-893
• 5 Heffron TG, Pillen T, Smallwood G , et al. Pediatric liver transplantation for acute liver failure at a single center: a 10-yr experience. Pediatr Transplant 2010; 14 (2) 228-232
• 6 Szymczak M, Kalicinski P, Kaminski A , et al. Liver transplantation across ABO blood groups in children. Transplant Proc 2003; 35 (6) 2273-2274
• 7 Markiewicz-Kijewska M, Kaliciński P, Teisseyre J , et al. Liver transplantation with ABO incompatible graft under immunoadsorption protocol—case report. Ann Transplant 2010; 15 (4) 68-71
• 8 Gelas T, McKiernan PJ, Kelly DA, Mayer DA, Mirza DF, Sharif K. ABO-incompatible pediatric liver transplantation in very small recipients: Birmingham's experience. Pediatr Transplant 2011; 15 (7) 706-711
• 9 Ueda M, Oike F, Ogura Y , et al. Long-term outcomes of 600 living donor liver transplants for pediatric patients at a single center. Liver Transpl 2006; 12 (9) 1326-1336
• 10 Kawagishi N, Takeda I, Miyagi S , et al. Long-term outcome of ABO-incompatible living-donor liver transplantation: a single-center experience. J Hepatobiliary Pancreat Surg 2009; 16 (4) 468-472
• 11 Egawa H, Teramukai S, Haga H, Tanabe M, Fukushima M, Shimazu M. Present status of ABO-incompatible living donor liver transplantation in Japan. Hepatology 2008; 47 (1) 143-152
• 12 Varela-Fascinetto G, Treacy SJ, Lillehei CW , et al. Long-term results in pediatric ABO-incompatible liver transplantation. Transplant Proc 1999; 31 (1-2) 467-468
• 13 Yamada Y, Hoshino K, Morikawa Y , et al. Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia. J Pediatr Surg 2006; 41 (12) 1976-1979