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 I 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 El, 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 Immoral 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 Immoral rejection or late biliary complications using this combined antirejection strategy, even in older children. (c) 2006 Elsevier Inc. All rights reserved.