Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia

Yohei Yamada, Ken Hoshino, Yasuhide Morikawa, Jun Okamura, Ryo Hotta, Koji Komori, Shioko Nakao, Hideaki Obara, Shigeyuki Kawachi, Yasushi Fuchimoto, Minoru Tanabe, Motohide Shimazu, Masaki Kitajima

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Abstract

Background: The problem of ABO-incompatible liver transplantation still remains unsolved in older children. In this article, we report on our experience of 6 successful ABO-incompatible liver transplantations in patients with biliary atresia. Material and Methods: Six patients (ABO incompatibility type A→O:1 case, B→O:2 cases, A→B:3 cases) were enrolled in this study; 3 patients were aged approximately 1 year and the other 3 ranged in age from 9 to 24 years at the time of transplantation. Each patient received perioperative plasma exchange, until the anti-donor blood-type antibody titers became less than 1:16, and also systemic multidrug immunosuppressive therapy (cyclophosphamide, prednisolone, and tacrolimus). We applied the protocol of intraportal infusion therapy (local administration of prostaglandin E1, steroid, and gabexate mesilate via a portal vein catheter), splenectomy, and rituximab administration for the older group. Results: Both the patient and graft survival rates remain at 100%, with the follow-up period of the patients ranging from 12 and 123 months. Acute cellular rejection occurred in 2 cases, and both were steroid sensitive. There was no incidence of humoral rejection. Although all cases developed viral infection, all recovered uneventfully with the administration of antiviral agents. Conclusion: ABO-incompatible liver transplantation can be performed with a low risk of humoral rejection or late biliary complications using this combined antirejection strategy, even in older children.

Original languageEnglish
Pages (from-to)1976-1979
Number of pages4
JournalJournal of Pediatric Surgery
Volume41
Issue number12
DOIs
Publication statusPublished - 2006 Dec 1

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Keywords

  • ABO incompatible liver transplantation
  • Children
  • Humoral rejection
  • Intraportal infusion therapy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Yamada, Y., Hoshino, K., Morikawa, Y., Okamura, J., Hotta, R., Komori, K., Nakao, S., Obara, H., Kawachi, S., Fuchimoto, Y., Tanabe, M., Shimazu, M., & Kitajima, M. (2006). Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia. Journal of Pediatric Surgery, 41(12), 1976-1979. https://doi.org/10.1016/j.jpedsurg.2006.08.021