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

Research output: Contribution to journalArticle

15 Citations (Scopus)

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

Fingerprint

Biliary Atresia
Liver Transplantation
Gabexate
Steroids
Plasma Exchange
Alprostadil
Tacrolimus
Graft Survival
Splenectomy
Virus Diseases
Immunosuppressive Agents
Portal Vein
Prednisolone
Blood Donors
Cyclophosphamide
Antiviral Agents
Catheters
Survival Rate
Transplantation
Antibodies

Keywords

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

ASJC Scopus subject areas

  • Surgery

Cite this

Yamada, Y., Hoshino, K., Morikawa, Y., Okamura, J., Hotta, R., Komori, K., ... 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

Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia. / Yamada, Yohei; Hoshino, Ken; Morikawa, Yasuhide; Okamura, Jun; Hotta, Ryo; Komori, Koji; Nakao, Shioko; Obara, Hideaki; Kawachi, Shigeyuki; Fuchimoto, Yasushi; Tanabe, Minoru; Shimazu, Motohide; Kitajima, Masaki.

In: Journal of Pediatric Surgery, Vol. 41, No. 12, 12.2006, p. 1976-1979.

Research output: Contribution to journalArticle

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, vol. 41, no. 12, pp. 1976-1979. https://doi.org/10.1016/j.jpedsurg.2006.08.021
Yamada, Yohei ; Hoshino, Ken ; Morikawa, Yasuhide ; Okamura, Jun ; Hotta, Ryo ; Komori, Koji ; Nakao, Shioko ; Obara, Hideaki ; Kawachi, Shigeyuki ; Fuchimoto, Yasushi ; Tanabe, Minoru ; Shimazu, Motohide ; Kitajima, Masaki. / Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia. In: Journal of Pediatric Surgery. 2006 ; Vol. 41, No. 12. pp. 1976-1979.
@article{44bc2a14558e4d0988e798cd3b11499e,
title = "Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia",
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.",
keywords = "ABO incompatible liver transplantation, Children, Humoral rejection, Intraportal infusion therapy",
author = "Yohei Yamada and Ken Hoshino and Yasuhide Morikawa and Jun Okamura and Ryo Hotta and Koji Komori and Shioko Nakao and Hideaki Obara and Shigeyuki Kawachi and Yasushi Fuchimoto and Minoru Tanabe and Motohide Shimazu and Masaki Kitajima",
year = "2006",
month = "12",
doi = "10.1016/j.jpedsurg.2006.08.021",
language = "English",
volume = "41",
pages = "1976--1979",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",
number = "12",

}

TY - JOUR

T1 - Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia

AU - Yamada, Yohei

AU - Hoshino, Ken

AU - Morikawa, Yasuhide

AU - Okamura, Jun

AU - Hotta, Ryo

AU - Komori, Koji

AU - Nakao, Shioko

AU - Obara, Hideaki

AU - Kawachi, Shigeyuki

AU - Fuchimoto, Yasushi

AU - Tanabe, Minoru

AU - Shimazu, Motohide

AU - Kitajima, Masaki

PY - 2006/12

Y1 - 2006/12

N2 - 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.

AB - 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.

KW - ABO incompatible liver transplantation

KW - Children

KW - Humoral rejection

KW - Intraportal infusion therapy

UR - http://www.scopus.com/inward/record.url?scp=33845229330&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33845229330&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2006.08.021

DO - 10.1016/j.jpedsurg.2006.08.021

M3 - Article

VL - 41

SP - 1976

EP - 1979

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

IS - 12

ER -