Novel Strategies for Living Donor Liver Transplantation Across the ABO Blood Group Barrier: Effect of Intraportal Infusion Therapy
ABO-incompatible liver transplantation is associated with an extremely complicated postoperative course, especially when the recipients are adults and older children. The recipient’s preexisting antibody for donor-blood-group antigen induces serious rejection with a high incidence biliary and vascular complications. We had two cases of successful adult living donor liver transplantation across the ABO blood group barrier using intraportal infusion therapy, a novel antirejection regimen. Patient 1 was a 52-year-old woman with primary biliary cirrhosis (blood group O). She underwent living donor liver transplantation on November 16, 1998, using the left lobe graft from her son (blood group A). Patient 2 was a 45-year-old man referred with subacute hepatic failure of unknown etiology (blood group A). Living donor liver transplantation was performed on June 4, 2000, using a right lobe graft from his younger brother (blood group AB). Preoperatively, antidonor blood group antibody was removed by multiple plasmaphereses, and cyclophosphamide was administered for immunosuppression. Splenectomy was performed during transplantation; and tacrolimus, steroids, and cyclophosphamide were given postoperatively for basic systemic immunosuppression. In addition to these conventional therapies, methylprednisolone, prostaglandin E1, and gabexate mesylate were infused postoperatively from the graft portal vein catheter that had been inserted during the operation.