ACCEPTANCE OF ABO-INCOMPATIBLE LIVING DONOR LIVER TRANSPLANTATIONS WITH THE USE OF ANTIGEN-SPECIFIC IMMUNOADSORPTION (GLYCOSORB® ABO), DACLIZUMAB AND MYCOPHENOLATE MOFETIL WITHOUT SPLENECTOMY.

Abstract

P526 Aims: Introduction: Graft and patient survival rates in recipients of AB0 incompatible (AB0-I) liver transplantation is poor due to the greater incidence of vascular thrombosis, biliary injury and acute cellular rejection (ACR). AB0 mismatch liver transplantation is controversial especially in non-urgent situations and in living donor liver transplantation. We investigate a new protocol consisting on antigen-specific immunoadsorption (ASIAD) using Glycosorb® AB device that remove only blood group antibodies, associated with daclizumab and mycophenolate mofetil induction without splenectomy in living donor liver transplantation in adults (AALDLT). Methods: Between January and April 2003, 2 out of 10 recipients underwent AB0-I (A1>0; A2>B) AALDLT with the right lobe in our institution. Case 1 was a man 45 y.o. and case 2 was a man 52 y.o., underwent transplantation for multifocal HCC on HCV-related cirrhosis both. HSA was performed on preoperative day -2 and -1 and following AALDLT according to the anti-IgM/IgG titer increase. Immunosuppressive regimen consisted on daclizumab (1mg/Kg) induction on day -1; 1; 15; 30; 45; mycophenolate mofetil 2 × 1 g on day – 1; 0 and each postoperative day; tacrolimus 2 × 1 mg on day -1 and each postoperative day with doses adjusted to maintain serum through levels of 12-15 ng/dl. Conventional steroid tapering doses was administered. Results: After a median FU of 13 months, both patients are alive and well. In patient 1, preoperative anti-IgM/IgG titer before and after ASIAD fall from 128 to 4 and from 64 to 0 respectively. Five ASIAD sessions were required in total and no ACR episodes occurred. Anti IgG titers remained between 1 and 8. In patient 2, preoperative anti IgM/IgG titers fall from 4 to 0 and from 32 to 2. Seven ASIAD sessions were required. This patient experienced two episodes of ACR grade 2 on the third postoperative week and at 6 months. Anti IgG titers remained between 2 and 16. Both patients did not experienced major complications or infections episodes or CMV disease. After a FU of 15 and 12 months, a specific hemagglutinins level remains low. Conclusions: Antigen-specific immunoadsorption with Glycosorb AB® has showed high efficiency to decrease significantly hemagglutinins without any adverse event. The favourable outcome of these patients enrolled in this protocol using Daclizumab and Mycophenolate Mofetil could be explained by the induction of accommodation. This treatment may potentially expand the donor pool in AALDLT.