Status 1A ABO Incompatible Liver Transplant With Eculizumab as a Rescue Treatment for a Patient With Primary Non-Function: Case Report

Primary graft non-function (PNF) after liver transplant (LT) due to graft necrosis necessitates urgent graftectomy and Status 1A liver re-transplant. To find a suitable donor promptly, ABO blood type incompatibility (ABOi) is a crucial immunological barrier. We present the case of a 68-year-old man with nonalcoholic steatohepatitis cirrhosis (model of end stage liver disease score = 23) who underwent an initial LT. Unfortunately, the transplant was complicated by portal vein thrombosis and hemodynamic instability, resulting in primary graft non-function. An emergent explant was performed, and the patient was an-hepatic for 16 hours with a portocaval shunt for status 1A LT. The first available donor was an ABOi 34-year-old man, and re-transplantation was performed with a single dose of Eculizumab administered 2 hours before reperfusion as part of a desensitization protocol. The ABO blood type antibody titer of the recipient before receiving Eculizumab was 1:128. Notably, plasmapheresis and immunoglobulin therapy were not required, simplifying management for this hemodynamically unstable patient. The patient was discharged without any sign of rejection or complication related to the re-transplantation. This case report underscores the significance of Eculizumab as an alternative desensitization strategy for ABOi LT hemodynamically unstable patients listed as Status 1A.