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ABO Incompatible Living Donor Liver Transplantation: A Single Center Experience
J Korean Soc Transplant 2018;32:84-91
Published online December 31, 2018
© 2018 The Korean Society for Transplantation.

Seung Hoon Lee, M.D.1, Ho Joong Choi, M.D.2, Young Kyoung You, M.D.2, Dong Goo Kim, M.D.2 and Gun Hyung Na, M.D.1

Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea1, Bucheon, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea2, Seoul, Korea
Correspondence to: Gun Hyung Na
Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon 14647, Korea
Tel: 82-32-340-7104, Fax: 82-32-340-2036
E-mail: nagh0214@naver.com
Received July 8, 2018; Revised October 25, 2018; Accepted October 26, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: This study examined the outcomes of ABO incompatible living donor liver transplantation (LDLT). The changes in the immunologic factors that might help predict the long term outcomes were also studied.
Methods: Twenty-three patients, who underwent ABO incompatible LDLT from 2010 to 2015, were reviewed retrospectively. The protocol was the same as for ABO compatible LDLT except for the administration of rituximab and plasma exchange. The clinical outcomes and immunologic factors, such as isoagglutinin titer and cluster of differentiation 20+ (CD20+) lymphocyte levels were reviewed.
Results: The center showed a 3-year survival of 64% with no case of antibody-mediated rejection. When transplantation-unrelated mortalities (for example, traffic accidents and myocardial infarction) were removed from statistical analysis, the 3-year survival was 77.8%. Although isoagglutinin titers continued to remain at low levels, the CD20+ lymphocyte levels recovered to the pre-Rituximab levels at postoperative one year.
Conclusions: As donor shortages continue, ABO incompatible liver transplantation is a feasible method to expand the donor pool. On the other hand, caution is still needed until more long-term outcomes are reported. Because CD20+ lymphocytes are recovered with time, more immunologic studies will be needed in the future.
Keywords : ABO blood-group system, B-lymphocytes, Hemagglutinins, Liver transplantation, Survival


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