Abstract
BackgroundABO-incompatible live donor liver transplant (ABOi-LDLT) is being widely done to bridge the gap of demand and supply of organs. Different desensitization regimes are being used to reduce titer of blood group antibodies for successful transplant and accommodation of graft. The authors used cascade plasmapheresis (CP) to bring down titer of naturally occurring blood group antibody to 16 or lower.Material and methodsFour recipients of ABOi-LDLT were of blood groups O, O, B, and B while donors were of blood groups B, A, AB, and AB, respectively. Desensitization protocol included immunosuppressive drugs and plasmapheresis. CP consisted of separating patient’s plasma as the first step and passing it through pore size based filter column as the second step. The first step was performed using disposable kit (PL1, Fresenius Kabi, Germany) with minor modification on apheresis equipment COM.TEC (Fresenius Kabi, Germany). Pore size based filter column used was 2A column (Evaflux, Kawasumi Laboratories, Japan). Blood group antibody titer (immunoglobulin G (IgG)) was done by column agglutination technology (Ortho-Clinical Diagnostics).ResultsCases 1, 2, 3, and 4 with pre-CP titer of 1,024, 512, 32, and 64 required four, three, one, and one CP procedures, respectively. No signs of antibody-mediated rejection were exhibited on histopathological evaluation by any of the patients. Successful organ engraftment occurred as documented by post-operative liver function tests and liver biopsy.ConclusionCascade plasmapheresis offers a cost-effective and efficient way to decrease blood group antibody titer and helps in successful transplant.
Highlights
ABO-incompatible live donor liver transplant (ABOi-LDLT) is being widely done to bridge the gap of demand and supply of organs
Immunosuppressive drugs inhibit the formation of new antibodies, and plasmapheresis lowers the titer of existing blood group antibodies
There is a report from India reiterating pivotal role of plasmapheresis in desensitization protocols leading to successful solid organ transplant and adequate patient follow-up after the transplant, as well [5]
Summary
ABO-incompatible live donor liver transplant (ABOi-LDLT) is being widely done to bridge the gap of demand and supply of organs. In India, the organ transplants are governed by Organ Donation Act [2], which allows only first-degree relatives or spouse to be donor(s) for the patient Sometimes this willing donor is not suitable on the grounds of ABO blood group incompatibility. In recent times, people have found their way around this ‘suitability issue’ by Desensitizing protocols play an important role in successful outcome of these transplants by decreasing the chances of acute antibody-mediated organ rejection [4]. These protocols include immunosuppressive drugs and plasmapheresis. We would like to present a case series of four consecutive ABOi-LDLT patients where we used cascade plasmapheresis (CP) successfully as a part of preconditioning regime to reduce the titer of naturally occurring antibody in ABO incompatible LDLT
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