The protocol in ABO-incompatible liver transplantation: 15 cases

Abstract

Objective To analysis the clinical effect and outcomes of 15 case of ABO-incompatible liver transplantation. Method The date of 15 cases ABO-incompatible liver transplantation between August 2013 to August 2015 was analyzed retrospectively. The age, primary disease, level of anti-blood group antibodies, preoperative and intraoperative parameters, postoperative complications and prognosis were analyzed. Among the 15 ABO-incompatible liver transplantation cases, 6 cases were children, age of the recipients was from 5.0 months to 39.6 months, and 5 cases were diagnosed as biliary atresia, 1 cases was diagnosed as progressive familial intrahepatic cholestasis type 1 (Byler disease); 9 cases were adults, age from 45.2 years to 69.6 years, among them, 5 patients were Hepatitis B virus (HBV) cirrhosis with HBV Hepatocellular carcinama, 2 patients were alcoholic cirrhosis and HCC, 2 patients were HBV liver cirrhosis. Result The antibody titer of IgM was 1∶4~1∶256 in patients before operation, and the antibody titer of IgG was 1∶4~1∶256 before operation. 4 cases underwent splenectomy during operation, 1 case underwent splenectomy 4 years before liver transplantation. 10 cases of patients injected with Rituximab, 375 mg/m2 preoperatively; 5 cases of pediatric patients did not use rituximab. All patients received intravenous immunoglobulin 400 mg·kg-1·d-1 during operation to 7 days. 2 patients died in the perioperative period, 1 patients died of tumor recurrence postoperation, and the remaining 12 patients were alive and the graft function was good. Conclusion The ABO-incompatible liver transplantation can obtain relatively satisfactory prognosis by preoperative evaluation and perioperation treatment with Rituximab injection and intravenous immunoglobulin. Key words: Liver transplantation; Child; ABO blood-group system; Blood group incompatibility; Living donor; Prognosis