Simultaneous ABO-incompatible living-donor liver transplantation and splenectomy without plasma exchange in China: Two case reports

Abstract

ABO-incompatible (ABO-i) living-donor liver transplantation (LDLT) is performed if an ABO-compatible graft cannot be obtained. However, a perfect desensitization protocol has not been established worldwide, especially for simultaneous ABO-i LDLT and splenectomy. We herein report two cases of ABO-i LDLT. To the best of our knowledge, this is the first case report of ABO-i LDLT in an adult patient in China. Splenectomy and T-cell-targeted immunosuppression (basiliximab) was used to overcome the blood group barrier in these recipients. The patients had good graft function without signs of antibody-mediated rejection throughout the 12-month follow-up. Thus, ABO-i LDLT with splenectomy is undoubtedly life-saving when an ABO-compatible graft cannot be obtained for patients in critical condition.

Feasibility of using marginal liver grafts in living donor liver transplantation

“…Rituximab is given for 3 d[ 93 ], 3 wk, or even as soon as a suitable donor that is ABO-compatible is selected[ 94 ] at a dosage of 375 mg/m 2 . In the early stage of transplantation, rituximab was usually given along with one or more other protocols, such as a splenectomy[ 95 , 96 ], plasma exchanges[ 97 - 102 ], intravenous IgG[ 100 , 103 ], and intrahepatic arterial infusion of prostaglandin E1[ 92 , 104 , 105 ]. In some recent studies, pre-transplant rituximab and/or basiliximab monotherapy, without additional treatments, also yielded outcomes that are comparable to those of procedures with additional treatments[ 106 ].…”