Results of XXXX -Incompatible Liver Transplantation Using a Simplified Protocol at a Single Institution.

@entity1 @entity6910 @entity55 @entity260 @entity281 @entity3851 @entity204 @entity6315 @entity479
BACKGROUND: Because of the development of various desensitization strategies, @entity6910 -incompatible (ABOi) living donor liver transplantation (LDLT) has become a feasible option for @entity1 with @entity3851 . However, there has been no united desensitization protocol for ABOi LDLT. We analyzed the outcomes after establishment of simplified protocol without splenectomy, intravenous immunoglobulin, and local infusion therapy. METHODS: We analyzed 19 ABOi LDLT cases that had been performed between January 2012 and December 2013, without splenectomy and local infusion. We used a single dose of rituximab (375  mg/m(2)) 10 days before transplantation and several series of plasma exchange according to the recipients' iso-agglutinin titer-to-target titer ratio of 1:32. RESULTS: Nineteen recipients received ABOi LTs from living donors. The mean initial immunoglobulin (Ig) M and IgG anti- @entity6910 titers were 76.63    78.81 (range, 8   256) and 162.53    464.1 (0   2048). We performed preoperative plasma exchange to 16 recipients (mean number of sessions, 3.58; range, 1-10). After surgery, 9 @entity1 received plasma exchange (mean, 1.84; range 1   14). One @entity204 occurred as the result of @entity55 (5.3%). There were 4 cases of acute rejections (21.1%), and all of them were treated successfully with @entity479 pulse or thymoglobulin. Antibody-mediated rejection and graft failure did not occur. Six cases of @entity260 (31.6%) occurred, including 3 cases of @entity281 . There were 2 cases of biliary anastomotic stricture (10.5%) and 1 case of @entity6315 (5.3%). CONCLUSIONS: ABOi LDLT with the use of simplified protocol can be safely performed without increased risk of antibody-mediated rejection and other complications.
