For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have...For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible(AB0i) grafts. Improvements in AB0 i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0 i living donor liver transplantation(LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0 i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients' graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0 i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0 i LDLT is a feasible option today and almost free of severe complications.展开更多
BACKGROUND Although ABO-nonidentical and ABO-incompatible liver transplantation(LT)are other options for end-stage liver disease treatment,the development of antibodies against blood group antigens(anti-A/B antibodies...BACKGROUND Although ABO-nonidentical and ABO-incompatible liver transplantation(LT)are other options for end-stage liver disease treatment,the development of antibodies against blood group antigens(anti-A/B antibodies)is still a challenge in managing and follow-up of the recipients.CASE SUMMARY A 56-year-old male with end-stage liver disease with rapid deterioration and poor prognosis was considered to receive a deceased ABO-nonidentical liver graft.All required tests were performed according to our pre-LT diagnostic protocol.The orthotopic LT procedure involving O+donor and A1B+recipient was performed.Our treatment strategy to overcome the antibodymediated rejection included a systemic triple immunosuppressive regimen:methylprednisolone,mycophenolate mofetil,and tacrolimus.The immunological desensitization consisted of the chimeric anti-CD20 monoclonal antibody rituximab and intravenous immunoglobulins.The patient was also on antibiotic treatment with amoxicillin/clavulanate,cefotaxime,and metronidazole.On the 10th postoperative day,high titers of IgG anti-A and anti-B antibodies were found in the patient’s plasma.We performed a liver biopsy,which revealed histological evidence of antibody-mediated rejection,but the rejection was excluded according to the Banff classification.The therapy was continued until the titer decreased significantly on the 18th postoperative day.Despite the antibiotic,antifungal,and antiviral treatment,the patient deteriorated and developed septic shock with anuria and pancytopenia.The conservative treatment was unsuccessful,which lead to the patient’s fatal outcome on the 42nd postoperative day.CONCLUSION We present a patient who underwent ABO-nonidentical LT from a deceased donor.Even though we implemented the latest technological advancements and therapeutic approaches in the management of the patient and the initial results were promising,due to severe infectious complications,the outcome was fatal.展开更多
文摘For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible(AB0i) grafts. Improvements in AB0 i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0 i living donor liver transplantation(LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0 i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients' graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0 i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0 i LDLT is a feasible option today and almost free of severe complications.
文摘BACKGROUND Although ABO-nonidentical and ABO-incompatible liver transplantation(LT)are other options for end-stage liver disease treatment,the development of antibodies against blood group antigens(anti-A/B antibodies)is still a challenge in managing and follow-up of the recipients.CASE SUMMARY A 56-year-old male with end-stage liver disease with rapid deterioration and poor prognosis was considered to receive a deceased ABO-nonidentical liver graft.All required tests were performed according to our pre-LT diagnostic protocol.The orthotopic LT procedure involving O+donor and A1B+recipient was performed.Our treatment strategy to overcome the antibodymediated rejection included a systemic triple immunosuppressive regimen:methylprednisolone,mycophenolate mofetil,and tacrolimus.The immunological desensitization consisted of the chimeric anti-CD20 monoclonal antibody rituximab and intravenous immunoglobulins.The patient was also on antibiotic treatment with amoxicillin/clavulanate,cefotaxime,and metronidazole.On the 10th postoperative day,high titers of IgG anti-A and anti-B antibodies were found in the patient’s plasma.We performed a liver biopsy,which revealed histological evidence of antibody-mediated rejection,but the rejection was excluded according to the Banff classification.The therapy was continued until the titer decreased significantly on the 18th postoperative day.Despite the antibiotic,antifungal,and antiviral treatment,the patient deteriorated and developed septic shock with anuria and pancytopenia.The conservative treatment was unsuccessful,which lead to the patient’s fatal outcome on the 42nd postoperative day.CONCLUSION We present a patient who underwent ABO-nonidentical LT from a deceased donor.Even though we implemented the latest technological advancements and therapeutic approaches in the management of the patient and the initial results were promising,due to severe infectious complications,the outcome was fatal.
