scholarly journals Is ABO-Incompatible Living Donor Liver Transplantation Really a Good Alternative for Pediatric Recipients?

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 600
Author(s):  
Catherine de Magnée ◽  
Louise Brunée ◽  
Roberto Tambucci ◽  
Aurore Pire ◽  
Isabelle Scheers ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Humoral Rejection ◽  
Donor Liver ◽  
Retrospective Case ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection

Background: ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been proposed to compensate for donor shortage. To date, few studies have reported detailed ABOi LDLT results in large series of pediatric patients. C4d complement deposition in graft capillaries has been reported to be associated with antibody-mediated rejection in solid organ transplantation. Methods: A retrospective case–control study was conducted, comparing clinical outcomes of each of 34 consecutive pediatric ABOi LDLT recipients with those of 2 non-ABOi pairs (n = 68), matched according to pre-transplant diagnostic criteria, age, and date of transplantation. In addition, we studied the C4d immunostaining pattern in 22 ABOi and in 36 non-ABOi recipients whose liver biopsy was performed within the first 4 post-transplant weeks for suspected acute rejection. Results: The incidence of biliary complications was higher in ABOi recipients (p < 0.05), as were the incidence of acute humoral rejection (p < 0.01) and the incidence of retransplantation (p < 0.05). All children who required retransplantation were older than 1 year at the time of ABOi LDLT. Positive C4d immunostaining was observed in 13/22 (59%) ABOi recipients versus 3/36 (8.3%) non-ABOi recipients (p < 0.0001). Conclusions: ABOi LDLT is a feasible option for pediatric end-stage liver disease but carries increased risks for the recipient, especially for children older than 1 year, even with a specific preparation protocol. C4d immunostaining may be a hallmark of acute humoral rejection in ABOi liver transplantation.

scholarly journals Resuming post living donor liver transplantation in the COVID-19 pandemic: real-life experience, single-center experience

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Abeer Awad Abdellatif ◽  
Mohamad Sherif Mogawer ◽  
Mostafa El- Shazli ◽  
Hanaa El-Karaksy ◽  
Ayman Salah ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Good Condition ◽  
Solid Organ Transplantation ◽  
Real Life ◽  
Solid Organ ◽  
Single Center ◽  
Donor Liver ◽  
Donor Liver Transplantation

Abstract Background Solid organ transplantation (SOT) service has been disrupted during the current coronavirus disease 2019 (COVID-19) pandemic, which deferred the service in most centers worldwide. As the pandemic persists, there will be an urgency to identify the best and safest practices for resuming activities as areas re-open. Resuming activity is a difficult issue, in particular, the decision of reopening after a period of slowing down or complete cessation of activities. Objectives To share our experience in resuming living donor liver transplantation (LDLT) in the context of the COVID-19 pandemic in the Liver Transplantation Unit of El-Manial Specialized Hospital, Cairo University, Egypt, and to review the obstacles that we have faced. Material and methods This study is a single-center study. We resumed LDLT by the 26th of August 2020 after a period of closure from the 1st of March 2020. We have taken a lot of steps in order to prevent COVID-19 transmission among transplant patients and healthcare workers (HCWs). Results In our study, we reported three LDLT recipients, once resuming the transplantation till now. All our recipients and donors tested negative for SARS-CoV-2 by nasopharyngeal RT-PCR a day before the transplantation. Unfortunately, one of them developed COVID-19 infection. We managed rapidly to isolate him in a single room, restricting one team of HCWs to deal with him with strict personal protective measures. Finally, the patient improved and was discharged in a good condition. The second patient ran a smooth course apart from FK neurotoxicity which improved with proper management. The third patient experienced a sharp rise in bilirubin and transaminases on day 14 that was attributed to drug toxicity vs. rejection and managed by discontinuing the offending drugs and pulse steroids. In addition, one of our head nurses tested positive for SARS-CoV-2 that was manageable with self-isolation. Conclusion Careful patient, donor, personnel screening is mandatory. Adequate supply of personal protective equipments, effective infection control policies, and appropriate administrative modifications are needed for a safe return of LDLT practice.

scholarly journals A Mortality Case Caused by Thrombotic Microangiopathy after Successful Bloodless Living Donor Liver Transplantation

2021 ◽  
Vol 27 (2) ◽  
pp. 85-87
Author(s):  
Sun Young Park ◽  
Ho Bum Cho ◽  
Gyu Wan You ◽  
Kyeong Sik Kim
Keyword(s):  
Liver Transplantation ◽  
Thrombotic Microangiopathy ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Solid Organ Transplantation ◽  
Clinical Manifestations ◽  
Solid Organ ◽  
Donor Liver ◽  
Drug Induced ◽  
Donor Liver Transplantation

Thrombotic microangiopathy (TMA) after solid organ transplantation is infrequent and its etiology remains still unclear. Nevertheless, if early diagnosis and early therapies are not performed, it can lead to severe life-threatening complications and even death. A 54-year-old female (a Jehovah’s Witness) was diagnosed with drug-induced toxic hepatitis and was decided to undergo bloodless living donor liver transplantation (LDLT). After the successful LDLT, the patient’s condition deteriorated, and she was diagnosed with TMA during further evaluation. We tried to proceed with plasma exchange-based treatment, but she and her family declined according to their religious beliefs. The patient expired 4 days after the diagnosis. Physicians should maintain a high level of suspicion for TMA after liver transplantation when clinical manifestations are observed.

scholarly journals Bortezomib Against Refractory Antibody-Mediated Rejection After ABO-Incompatible Living-Donor Liver Transplantation

2019 ◽  
Vol 5 (10) ◽  
pp. e491 ◽  
Author(s):  
Tetsuya Tajima ◽  
Koichiro Hata ◽  
Hideaki Okajima ◽  
Momoko Nishikori ◽  
Kentaro Yasuchika ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection

scholarly journals Clinical Relevance of Isoagglutinin Rebound in Adult ABO-Incompatible Living Donor Liver Transplantation

2021 ◽  
Vol 11 (12) ◽  
pp. 1300
Author(s):  
Wei-Chen Lee ◽  
Chen-Fang Lee ◽  
Tsung-Han Wu ◽  
Hao-Chien Hung ◽  
Jin-Chiao Lee ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Graft Loss ◽  
Initial Assessment ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection ◽  
Group A ◽  
Group B

ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) can be performed successfully. However, anti-ABO isoagglutinin rebound may cause antibody-mediated rejection (AMR) and graft loss. The risk threshold of isoagglutinin rebound is still not defined. 76 ABO-I LDLT recipients were divided into group A (n = 56) with low isoagglutinin titers (<1:256), and group B (n = 20) with high isoagglutinin titers (≥1:256), at initial assessment for liver transplantation. The last 12 patients in group B received a modified desensitization regimen by adding bortezomib to deplete plasma cells. Six (10.7%) patients in group A and 10 (50.0%) patients in group B had postoperative isoagglutinin rebound (p < 0.001). Three patients (5.54%) in group A and two patients (10%) in group B developed clinical AMR (p = 0.602). The cutoff value of postoperative isoagglutinin rebound to cause clinical AMR was ≥1:1024. Among the 12 patients in group B with bortezomib administration, isoagglutinin rebounded up to 1:128 only, and no clinical AMR occurred. In conclusion, the patients with high isoagglutinin titers had a higher rate of postoperative isoagglutinin rebound. Isoagglutinin rebound ≥1:1024 is risky for developing clinical AMR. Adding bortezomib into the desensitization regimen may mitigate isoagglutinin rebound, and avoid clinical AMR.

scholarly journals Simultaneous ABO-incompatible living-donor liver transplantation and splenectomy without plasma exchange in China: Two case reports

2017 ◽  
Vol 45 (6) ◽  
pp. 2146-2152 ◽  
Author(s):  
Guoyong Chen ◽  
Janjun Sun ◽  
Sidong Wei ◽  
Yongfeng Chen ◽  
Gaofeng Tang ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Case Reports ◽  
Graft Function ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection ◽  
First Case ◽  
Life Saving

ABO-incompatible (ABO-i) living-donor liver transplantation (LDLT) is performed if an ABO-compatible graft cannot be obtained. However, a perfect desensitization protocol has not been established worldwide, especially for simultaneous ABO-i LDLT and splenectomy. We herein report two cases of ABO-i LDLT. To the best of our knowledge, this is the first case report of ABO-i LDLT in an adult patient in China. Splenectomy and T-cell-targeted immunosuppression (basiliximab) was used to overcome the blood group barrier in these recipients. The patients had good graft function without signs of antibody-mediated rejection throughout the 12-month follow-up. Thus, ABO-i LDLT with splenectomy is undoubtedly life-saving when an ABO-compatible graft cannot be obtained for patients in critical condition.

scholarly journals RISK FACTOR AND TREATMENT FOR CHRONIC ANTIBODY MEDIATED REJECTION AFTER PEDIATRIC LIVING DONOR LIVER TRANSPLANTATION

2020 ◽  
Vol 104 (S3) ◽  
pp. S510-S510
Author(s):  
Seiichi Shimizu ◽  
Seisuke Sakamoto ◽  
Akinari Fukuda ◽  
Yusuke Yanagi ◽  
Hajime Uchida ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Risk Factor ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Antibody Mediated Rejection
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