The changes in treatment strategies in ABOi living donor liver transplantation for acute liver failure

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  • Yasuda Mitsuhiro
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Ikegami Toru
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Imai Daisuke
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Wang Huanlin
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Bekki Yuki
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Itoh Shinji
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Yoshizumi Tomoharu
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Soejima Yuji
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Shirabe Ken
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University
  • Maehara Yoshihiko
    Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University

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Abstract

Introduction. Living donor liver transplantation (LDLT) using ABO-incompatible (ABOi) graft for acute liver failure (ALF) is a developing treatment modality. Methods. We reviewed the changes in our treatment strategies in applying ABOi LDLT for FH over our fourteen years of experience. Results. Five patients with ALF received LDLT in adults using ABOi grafts, with different but gradually renewed protocols. The etiologies for acute liver failure included autoimmune hepatitis (n=3) and unknown (n=2). The desensitization protocol for ABOi barrier included Case #1; local infusion (portal vein)+plasma exchange (PE), Case #2; local infusion (hepatic artery)+rituximab+PE, Case #3 and #4; rituximab+PE, and Case #5; rituximab+PE under high-flow continuous hemodiafiltration. Local infusion was abandoned since Case #3, because Case #1 had portal vein thrombosis resulting in graft necrosis and Case #2 had hepatic artery dissection. The patients (Case #2 and #3), who received rituximab within 7 days before LDLT, experienced antibody-mediated rejection. Thus, the most recent protocol for ABOi-LDLT is that rituximab is given 2 weeks before LDLT, followed by high-flow continuous hemodiafiltration to obstacle hepatic encephalopathy until LDLT. The four patients except Case #1 are doing well with good graft function over 3.8±3.7 years. Conclusion. Rituximab-based ABOi-LDLT, most-recently under high-flow hemodiafiltration for treating encephalopathy, is a feasible option for applying LDLT for ALF. J. Med. Invest. 62: 184-187, August, 2015

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