Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases.

Clinical transplantation and research Pub Date : 2025-06-30 Epub Date: 2025-02-18 DOI:10.4285/ctr.24.0061
Nalini Kanta Ghosh, Kausar Makki, Yogesh Yadav, Tathagata Karan, Piyush Srivastava, Anil Agarwal, Vivek Vij
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Abstract

ABO-incompatible (ABOi) living donor liver transplantation (LDLT) carries a substantial risk of antibody-mediated rejection (AMR) in both the short and long term. However, when no ABO-compatible donor is available, ABOi LDLT can be a viable option for patients with liver failure requiring emergency transplantation. To prevent AMR, various strategies have been implemented. However, typically, a pretransplant preparation period of at least 2 to 3 weeks is required to reduce the CD19+ or CD20+ cell count and antibody levels to an acceptable threshold (1:64). In emergency ABOi cases, due to time constraints, the desensitization protocol must be modified in accordance with the patient's needs. We present a series of three cases involving emergency ABOi LDLT: one of primary graft nonfunction and two of acute-on-chronic liver failure. The goal was to achieve both short- and long-term rejection-free outcomes. Each case required different protocols based on the patient's antibody titer, clinical condition, and intraoperative findings, and postoperative immunosuppression regimens were also individualized according to each patient's clinical condition. This case series demonstrates the safety and feasibility of emergency ABOi LDLT with modifications to the desensitization protocol. However, further research into emergency ABOi transplantation is necessary to establish recommendations for managing such patients.

ABO血型不相容活体肝移植的紧急定制策略:三例系列病例。
abo不相容(ABOi)活体供肝移植(LDLT)在短期和长期都存在抗体介导的排斥反应(AMR)的重大风险。然而,当没有abo相容的供体时,对于需要紧急移植的肝功能衰竭患者,ABOi LDLT可能是一个可行的选择。为了预防抗菌素耐药性,已经实施了各种策略。然而,通常需要至少2至3周的移植前准备时间,以将CD19+或CD20+细胞计数和抗体水平降低到可接受的阈值(1:64)。在紧急ABOi病例中,由于时间限制,必须根据患者的需要修改脱敏方案。我们提出了一系列涉及急诊ABOi LDLT的三个病例:一个是原发性移植物功能不全,两个是急性慢性肝衰竭。目标是实现短期和长期的无排斥结果。每个病例需要根据患者的抗体滴度、临床情况和术中发现不同的方案,并且术后免疫抑制方案也根据每个患者的临床情况进行个体化。本病例系列证明了紧急ABOi LDLT的安全性和可行性,并修改了脱敏方案。然而,有必要对急诊ABOi移植进行进一步研究,以确定管理此类患者的建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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