Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients
The role of the isoagglutinin (IA) titer in liver transplantation (LT) is still not well defined, but the general belief is that a higher titer may result in a higher risk of rejection in ABO-incompatible living donor LT. To reduce the IA titer by 1:16 or lower, plasmapheresis is usually performed b...
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| Format: | Article |
| Language: | English |
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Korean Society for Transplantation
2020-06-01
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| Series: | Korean Journal of Transplantation |
| Subjects: | |
| Online Access: | http://journaleditor.inforang.com/journal/view.html?doi=10.4285/kjt.2020.34.2.109 |
| _version_ | 1827365353190064128 |
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| author | Boram Lee Jai Young Cho Hae Won Lee YoungRok Choi Yoo-Seok Yoon Ho-Seong Han |
| author_facet | Boram Lee Jai Young Cho Hae Won Lee YoungRok Choi Yoo-Seok Yoon Ho-Seong Han |
| author_sort | Boram Lee |
| collection | DOAJ |
| description | The role of the isoagglutinin (IA) titer in liver transplantation (LT) is still not well defined, but the general belief is that a higher titer may result in a higher risk of rejection in ABO-incompatible living donor LT. To reduce the IA titer by 1:16 or lower, plasmapheresis is usually performed before transplantation. However, there is no established protocol for patients for whom plasmapheresis has failed before reaching the target IA titers. Here, we report the cases of three patients who show high baseline IA titers and have failed plasmapheresis: no-response to plasmapheresis, allergic reaction associated with plasmapheresis, and anaphylactic reaction to platelet transfusion. For various reasons, after several plasmapheresis procedures, IA titers were not effectively reduced. In these patients, splenectomy and intravenous immunoglobulin (0.8 g/kg, from the anhepatic phase to 2 days after transplantation) were carried. The protocol biopsy on postoperative day 7 showed no histologic evidence of meaningful acute rejection. The main aim of this work is to demonstrate that we can apply this protocol to patients who have high baseline IA titers and have failed plasmapheresis. Furthermore, this report is enhanced to promote to the transplant community this approach with this type of recipient. |
| first_indexed | 2024-03-08T08:27:06Z |
| format | Article |
| id | doaj.art-13904a81cf78485ca01a53df4023298e |
| institution | Directory Open Access Journal |
| issn | 2671-8790 |
| language | English |
| last_indexed | 2024-03-08T08:27:06Z |
| publishDate | 2020-06-01 |
| publisher | Korean Society for Transplantation |
| record_format | Article |
| series | Korean Journal of Transplantation |
| spelling | doaj.art-13904a81cf78485ca01a53df4023298e2024-02-02T04:20:13ZengKorean Society for TransplantationKorean Journal of Transplantation2671-87902020-06-0134210911310.4285/kjt.2020.34.2.109kjt.2020.34.2.109Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patientsBoram Lee0Jai Young Cho1Hae Won Lee2YoungRok Choi3Yoo-Seok Yoon4Ho-Seong Han5Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaDepartment of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaDepartment of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaDepartment of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaDepartment of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaDepartment of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, KoreaThe role of the isoagglutinin (IA) titer in liver transplantation (LT) is still not well defined, but the general belief is that a higher titer may result in a higher risk of rejection in ABO-incompatible living donor LT. To reduce the IA titer by 1:16 or lower, plasmapheresis is usually performed before transplantation. However, there is no established protocol for patients for whom plasmapheresis has failed before reaching the target IA titers. Here, we report the cases of three patients who show high baseline IA titers and have failed plasmapheresis: no-response to plasmapheresis, allergic reaction associated with plasmapheresis, and anaphylactic reaction to platelet transfusion. For various reasons, after several plasmapheresis procedures, IA titers were not effectively reduced. In these patients, splenectomy and intravenous immunoglobulin (0.8 g/kg, from the anhepatic phase to 2 days after transplantation) were carried. The protocol biopsy on postoperative day 7 showed no histologic evidence of meaningful acute rejection. The main aim of this work is to demonstrate that we can apply this protocol to patients who have high baseline IA titers and have failed plasmapheresis. Furthermore, this report is enhanced to promote to the transplant community this approach with this type of recipient.http://journaleditor.inforang.com/journal/view.html?doi=10.4285/kjt.2020.34.2.109liver transplantation; plasmapheresis; graft rejection; splenectomy; immunoglobulinsintravenous |
| spellingShingle | Boram Lee Jai Young Cho Hae Won Lee YoungRok Choi Yoo-Seok Yoon Ho-Seong Han Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients Korean Journal of Transplantation liver transplantation; plasmapheresis; graft rejection; splenectomy; immunoglobulins intravenous |
| title | Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients |
| title_full | Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients |
| title_fullStr | Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients |
| title_full_unstemmed | Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients |
| title_short | Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients |
| title_sort | successful abo incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients |
| topic | liver transplantation; plasmapheresis; graft rejection; splenectomy; immunoglobulins intravenous |
| url | http://journaleditor.inforang.com/journal/view.html?doi=10.4285/kjt.2020.34.2.109 |
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