Successful ABO-incompatible pediatric liver transplantation utilizing standard immunosuppression with selective postoperative plasmapheresis
| Autor: | Jill De Paolo, Thomas G. Heffron, Todd Pillen, Phil Hagedorn, Gregory Smallwood, Patricia Douglas, Alexander Duncan, Massimo Asolati, John Rodriguez, D Welch, James R. Spivey, Enrique Martinez, Carlos G. Fasola, Chang Nam, Mark Guy, Rene Romero |
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| Rok vydání: | 2006 |
| Předmět: |
Graft Rejection
Male congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Adolescent medicine.medical_treatment Splenectomy Liver transplantation ABO Blood-Group System Daclizumab hemic and lymphatic diseases Cyclosporin a ABO blood group system parasitic diseases medicine Humans Child Immunosuppression Therapy Transplantation Hepatology business.industry Infant Immunosuppression Plasmapheresis biological factors Tacrolimus Liver Transplantation Surgery surgical procedures operative Blood Group Incompatibility Child Preschool Female business medicine.drug |
| Zdroj: | Liver Transplantation. 12:972-978 |
| ISSN: | 1527-6473 1527-6465 |
| Popis: | Transplanting blood group A, B, or O (ABO)-incompatible (ABO-I) liver grafts has resulted in lower patient and graft survival with an increased incidence of vascular and biliary complications and rejection. We report that, without modification of our standard immunosuppression protocol, crossing blood groups is an acceptable option for children requiring liver transplantation. In our study, ABO-I liver grafts -- regardless of recipient age -- have comparable long-term survival (mean follow-up of 3.25 yr) with ABO-compatible grafts without any difference in rejection, vascular or biliary complications. From January 1, 1999 to October 1, 2005, we studied 138 liver transplants in 121 children: 16 (13.2%) received an ABO incompatible liver allograft. One-year actuarial patient survival for ABO-matched grafts vs. ABO-I grafts was 93.0% and 100%, respectively, whereas graft survival was 83.4% and 92.3%. Additionally, 6 of 16 (37.5%) ABO-I transplanted children had 8 rejection episodes, whereas 47 patients (44.8%) had 121 rejection episodes in the ABO-compatible group. There were no vascular complications and 2 biliary strictures in the ABO-I group. Plasmapheresis was not used for pretransplantation desensitization and was only required in 1 posttransplantation recipient. No child was splenectomized. Six of the 16 children were older than 13 yr of age, suggesting the possibility of successfully expanding this technique to an older population. In conclusion, our outcomes may support the concept of using ABO-I grafts in a more elective setting associated with split and living donor liver transplants. |
| Databáze: | OpenAIRE |
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