ArticleIndian journal of gastroenterology : official journal of the Indian Society of Gastroenterology2019
Lessons learnt from living donor liver transplantation with ABO-incompatibility: A single-centre experience from southern India.
Article in Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed.
- Article
- Anaesthetic implications and transfusion practices in ABO incompatible living donor liver transplantation: Case series.Indian journal of anaesthesia · 2021Article
- Comment on "Lessons learnt from living donor liver transplantation with ABO-incompatibility: A single-center experience from southern India".Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2019Article
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5 authors.
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Abstract
backgroundAlthough, ABO-incompatible (ABOi) liver transplantation is considered a high-risk procedure, using newer and more effective preoperative B cell desensitisation techniques, many transplant centres are routinely performing ABOi living donor liver transplantation (LDLT).
methodsThis was a retrospective study of 12 patients (adult:pediatric = 10:2; M:F = 9:3; median age, 45.5 years [range 1 to 56 years]) who underwent ABOi LDLT at a tertiary care centre.
resultsThe median model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) scores were 28 (range 18 to 35) and 30.5 (range 24 to 37), respectively. For desensitisation, we initially used two doses of rituximab and two sessions of plasmapheresis preoperatively. We faced high mortality in the initial seven patients (five deaths) due to overwhelming sepsis from multidrug-resistant (MDR) pathogens. Subsequently, we restricted the rituximab to one dose and performed plasmapheresis only when isoagglutinin titre value was more than 1:64. With this regimen, out of the last five patients, four did well. For the whole cohort, the incidence of antibody-mediated rejection, acute cellular rejection, biliary complications, hepatic artery thrombosis, infection, and 5-year patient survival were 16.7%, 16.7%, 16.7%, 8.3%, 75%, and 40%, respectively. The risk factors for mortality were high MELD score, O blood group, and more intense desensitisation protocol.
conclusionsCareful selection of patients and less intense desensitisation protocol are probably important in improving the outcomes in ABOi LDLT.
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