Long-term outcomes of emergency ABO-incompatible living donor liver transplantation using a modified desensitization protocol for highly sensitized patients with acute liver failure: A case report.
Although there is no established desensitization protocol for liver transplantation (LT), desensitization usually entails treatment with rituximab, plasmapheresis, splenectomy, and intravenous immunoglobulin (IVIG) infusion together with a local graft. The desensitization protocol is usually initiated 2 to 3 weeks before transplantation. Therefore, patients with acute liver failure warranting urgent LT are usually ineligible for ABO-incompatible (ABOi) LT. For these reasons, several attempts have been made to abridge the desensitization protocol and extend the indication for ABOi living donor LT (LDLT). Here we report a 40-year-old female diagnosed with chronic hepatitis B and acute-on-chronic liver failure (model for end-stage liver disease score, 31). In the absence of a suitable compatible liver donor, emergency ABOi LT was planned using a modified desensitization protocol. The preoperative isoagglutinin (IA) titer was 1 : 1,024 and the preoperative T- and B-cell cross-matches were positive. The patient received a single dose of rituximab (375 mg/m2) and IVIG (0.8 g/kg) was administered from the anhepatic phase until three days after transplantation. Although the patient developed acute cellular rejection in the early stages after LT, she has maintained a stable graft function, even after 5 years. In summary, a modified desensitization protocol consisting of rituximab and IVIG is a feasible strategy for highly sensitized patients with elevated IA titers indicated for urgent LDLT.
['Lee|Boram|B|https://orcid.org/0000-0003-1567-1774', 'Cho|Jai Young|JY|https://orcid.org/0000-0002-1376-956X', 'Han|Ho-Seong|HS|https://orcid.org/0000-0001-9659-1260', 'Yoon|Yoo-Seok|YS|https://orcid.org/0000-0001-7621-8557', 'Lee|Hae Won|HW|https://orcid.org/0000-0002-3312-9295', 'Lee|Jun Suh|JS|https://orcid.org/0000-0001-9487-9826', 'Kim|Moonhwan|M|https://orcid.org/0000-0003-2772-0836', 'Choi|YoungRok|Y|https://orcid.org/0000-0003-2408-7086']
Liver transplantation Graft rejection Immunoglobulins, intravenous Liver failure, acute