Successful ABO-Incompatible Pediatric Liver Transplantation Utilizing Standard Immunosuppression With Selective Postoperative Plasmapheresis
|
|
- Pierce Reynolds
- 5 years ago
- Views:
Transcription
1 LIVER TRANSPLANTATION 12: , 2006 ORIGINAL ARTICLE Successful ABO-Incompatible Pediatric Liver Transplantation Utilizing Standard Immunosuppression With Selective Postoperative Plasmapheresis Thomas Heffron, 1,2 David Welch, 2 Todd Pillen, 2 Massimo Asolati, 6 Gregory Smallwood, 3 Phil Hagedorn, 2 Chang Nam, 2 Alexander Duncan, 4 Mark Guy, 2 Enrique Martinez, 4 James Spivey, 4 Patricia Douglas, 2 Carlos Fasola, 1 Jill De Paolo, 2 John Rodriguez, 1 and Rene Romero 2,5 1 Department of Surgery, Emory University School of Medicine, Atlanta, GA; 2 Children s Healthcare of Atlanta at Egleston, Atlanta, GA; 3 Department of Pharmacy, Emory University Hospital, Atlanta, GA; 4 Department of Medicine, Emory University School of Medicine, Atlanta, GA; 5 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; and 6 Dallas VA Medical Center, Dallas, TX Transplanting blood group A, B, or O (ABO)-incompatible (ABO-I) liver grafts has resulted in lower patient and graft survival with an increased incidence of vascular and biliary complications and rejection. We report that, without modification of our standard immunosuppression protocol, crossing blood groups is an acceptable option for children requiring liver transplantation. In our study, ABO-I liver grafts regardless of recipient age have comparable long-term survival (mean follow-up of 3.25 yr) with ABO-compatible grafts without any difference in rejection, vascular or biliary complications. From January 1, 1999 to October 1, 2005, we studied 138 liver transplants in 121 children: 16 (13.2%) received an ABO incompatible liver allograft. One-year actuarial patient survival for ABO-matched grafts vs. ABO-I grafts was 93.0% and 100%, respectively, whereas graft survival was 83.4% and 92.3%. Additionally, 6 of 16 (37.5%) ABO-I transplanted children had 8 rejection episodes, whereas 47 patients (44.8%) had 121 rejection episodes in the ABO-compatible group. There were no vascular complications and 2 biliary strictures in the ABO-I group. Plasmapheresis was not used for pretransplantation desensitization and was only required in 1 posttransplantation recipient. No child was splenectomized. Six of the 16 children were older than 13 yr of age, suggesting the possibility of successfully expanding this technique to an older population. In conclusion, our outcomes may support the concept of using ABO-I grafts in a more elective setting associated with split and living donor liver transplants. Liver Transpl 12: , AASLD. Received October 27, 2005; accepted February 2, Liver transplantation involving blood group A, B, and O (ABO)-incompatible (ABO-I) grafts has historically resulted in low patient and graft survival, along with a significantly higher incidence of acute cellular rejection, and increased postoperative hepatic vascular and biliary complications. This has limited the practice of crossing blood groups to emergent cases only. Many centers have developed novel immunosuppressive regimens in an attempt to improve the viability of ABO-I grafts and have included plasmapheresis and splenectomy. Rydberg et al. 1 suggests that crossing the ABObarrier may be successful particularly in children of younger age. However, ABO-I adult emergency liver transplantation still results in inferior patient and graft survival compared to ABO-identical transplants. Egawa et al. 2 concludes that ABO-I living donor transplants may be performed with relative safety in infants under 1 yr of age using standard immunosuppression. However, the same study found that children over 1 yr of age demonstrated poor long-term graft survival. 2 Reports of success with older age groups often detail small sample groups, such as the case reported Abbreviations: ABO, blood groups A, B, and O; ABO-I, ABO incompatible. Address reprint requests to Thomas Heffron, MD, 1405 Clifton Rd., Atlanta, GA Telephone: ; FAX: ; thomas.heffron@choa.org DOI /lt Published online in Wiley InterScience ( American Association for the Study of Liver Diseases.
2 PEDIATRIC ABO LIVER TRANSPLANTATION 973 TABLE 1. Immunosuppresive Protocol Months S/P transplantation or acute rejection Predisone per day CsA Level (monoclonal) Tacrolimus level 1 3 Child; 20 kg: 0.3 mg/kg qd; 20 kg: 7.5 mg qd ng/dl ng/dl 3 6 Child; 20 kg: 0.3 mg/kg qd; 20 kg: 5 mg qd ng/dl ng/dl 6 12 Child; 20 kg: 0.3 mg/kg qd; 20 kg: 2.5 mg qd ng/dl 5 10 ng/dl 12 Child; 20 kg: qod; 20 kg: 5 mg qod ng/dl 5 ng/dl Abbreviations; qd, quaquedie, everyday; qod, quaque altera die, every other day; S/P, status post, C s A, cyclosporine A. TABLE 2. Patient Demographics ABO incompatible ABO compatible P No. grafts Mean age (yr) NS Female 8 (50%) 70 (55.1%) NS Caucasian 7 66 NS African American 8 46 NS Asian 1 5 NS Hispanic 0 10 NS Abbreviation: NS, not significant. TABLE 3. Patient Outcomes ABO compatible grafts (n 122) ABO incompatible grafts (n 16) P Patients with HAT 7 0 NS Patients with bile duct 13 2 NS Rejection episodes NS Patients with rejections 47 6 NS Time to first rejection (days) % 1-yr actuarial patient survival NS % 1-yr actuarial graft survival NS Mean follow-up SD (days) NS Abbreviations: HAT, hepatic artery thrombosis; NS, not significant; SD, standard deviation. by Fang et al. 3 of a 59-year-old woman postoperatively treated with tacrolimus, mycophenolate mofetil, OKT3, steroids, and prostaglandin E1, as well as daily plasmapheresis, for 9 days after transplantation. Prolonged plasmapheresis, such as that noted by Fang et al., 3 is commonly employed in adult ABO-mismatch transplants. Farges et al. 4,5 asserts that increasing immunosuppression and using plasmapheresis postoperatively to reduce the titer of anti-a/b antibodies had little influence on the incidence of hyperacute rejection, vascular thrombosis, and biliary complications. Moreover, splenectomy as an immunosuppressive adjunct as described by Egawa et al., 2 Hanto et al., 6 and Monteiro et al. 7 is still used. In addition to perioperative splenectomy, Monteiro et al. relates the successful use of Rituximab and plasmapheresis immediately before and after ABO-I transplantation. 7 Herein, we report our immunosuppressive approach and surgical experience with ABO-I grafts in pediatric liver transplantation. PATIENTS AND METHODS From January 1, 1999 to October 1, 2005, we prospectively followed 138 pediatric liver transplant recipients under the age of 18 yr. Transplants were performed by a single surgeon. Of these, 16 children received an ABO-I graft (Tables 1-3). Recipient demographics, primary liver disease, biliary and vascular complications, retransplantation rate, patient and graft survival, rejection episodes, and follow-up time, were the variables analyzed from our database. All pediatric recipients were listed according to the United Network for Organ Sharing criteria. Mean follow-up was 3.25 yr. Blood type and cross-match with an irregular anti-
3 974 HEFFRON ET AL. body screen were performed on all children prior to transplantation. Isohemagglutinins titers were drawn pretransplantation only if irregular antibodies were found on initial screening. Isohemagglutinin titers against ABO antigens were monitored posttransplantation. According to our blood bank protocol, if clinically indicated, a positive A titer was considered to be related to the most common A1 antigen and A2 antigen tested. We defined indications for plasmapheresis as increased isohemagglutinin titers associated with allograft dysfunction, histological evidence of rejection, and/or clinical suspicion of antibody mediated response (i.e., hemolysis). Posttransplantation immunosuppression consisted of single-dose daclizumab, tacrolimus, mycophenolate mofetil, and methylprednisolone, and prednisone maintenance for 3 months. Intravenous methylprednisolone 20 mg/kg (up to a 1-gm maximum) was given at the time of the biliary anastomosis, followed by prednisone tapered to 0.3 mg/kg or a maximum of 20 mg/ day on postoperative day 7. Daclizumab was administered at 1 mg/kg and given once intravenously 12 to 24 hours posttransplantation. Mycophenolate mofetil was started orally at 30 mg/kg/day on postoperative day 1. Oral tacrolimus began on postoperative day 7. In the absence of rejection, steroids were discontinued within 12 months after transplantation. Exceptions from steroid withdrawal were children transplanted for autoimmune hepatitis or sclerosing cholangitis. If acute rejection occurred during the steroid wean, acute treatment was given with pulsed steroids, reinstitution of the oral prednisone, and increasing the calcineurin inhibitor trough to a therapeutic level. During both early and late phases of rejection, tacrolimus trough levels were maintained according to Table 1 and mycophenolate mofetil was administered at 15 mg/kg per day. Intravenous methylprednisolone pulse (10-20 mg/kg per dose) and increased tacrolimus trough level were used when antibody titers increased on serial isohemagglutinin assay, and/or evidence of increased indirect bilirubin, hematuria, positive direct antiglobulin test, or increased haptoglobin suggested hemolysis or antibody-mediated response. If the titers did not respond to methylprednisolone pulse and increased immunosuppression, we instituted plasmapheresis. Vascular anatomy of the transplanted liver was assessed by abdominal color doppler ultrasounds, performed intraoperatively and postoperatively for a minimum of 3 consecutive days. Liver biopsies were performed only when elevations in serial liver enzyme assay suggested allograft dysfunction. Standardized histologic grading of rejection was used. Clinical rejection is defined as an increase in the liver enzymes with corresponding liver biopsy or a clinical response to increasing tacrolimus and/or 1 bolus of intravenous steroids without liver biopsy. Immunohistochemistry to diagnose humoral rejection was not performed. Statistical analysis of the data was preformed by utilization of Student s t-test (2 tailed) for all continuous data when comparing 2 groups. When continuous data was compared within the same individuals, pair Student s t-test was utilized. Nominal data were compared by chi-squared and Fisher s exact test where appropriate, while survival was calculated by using actuarial data. Significance was considered P RESULTS Of 138 liver transplants (in 121 children) 54% were whole grafts and 46% were partial. A total of 16 ABO-I liver allografts (11.6%) were transplanted; 56.3% were in recipients greater than 3 yr of age and 37.5% in recipients older than 13 yr of age at the time of transplantation. Demographic information was similar between both ABO-I and ABO-compatible groups (Table 2). The blood group pairings included blood type B donors to type A liver recipient (B to A, n 4),AtoB (n 2),AtoO(n 7), and AB to A (n 3). The primary diagnoses at the time of transplantation of the 16 children included: fulminant hepatic failure (n 5); postnecrotic cirrhosis (n 3); biliary atresia with acute decompensation (n 3); and Alagille syndrome (n 1); 4 of these 16 transplantations were retransplantations due to primary nonfunction with initial diagnosis of cryptogenic cirrhosis (n 1), biliary atresia (n 2), and hemangioendothelioma (n 1). All ABO-I recipients had acute liver decompensation on chronic disease requiring admission to the pediatric intensive care unit and met the United Network for Organ Sharing criteria for status 1, except for 1 patient with Alagille syndrome (Pediatric End-Stage Liver Disease score 6) who received an AB liver not utilized by other programs. Posttransplantation surgical complications in the ABO-compatible group included hepatic artery thrombosis (n 7; 5.8%) and biliary complications (n 13; 10.7%). There were 2 biliary and no vascular complications in 16 ABO-I recipients (Table 3). The 2 children with biliary complications developed anastomotic strictures within 12 days of transplantation. One child had a left lateral living donor allograft with a small donor bile duct connected to a Roux-en-Y limb. Balloon dilatation with percutaneous biliary stenting for 2 weeks corrected the structural defect in this child. No longer term (more than 3 yr later) bile duct sequelae have occurred. The second adolescent developed an anastomotic stricture on postoperative day 13 that was stented percutaneously. He remains with this stent 11 months later. Neither patient had sustained hypotension, hepatic artery thrombosis, or severe allograft rejection that would predispose to biliary strictures. The 1-yr actuarial patient survival for ABO-compatible vs. ABO-I grafts was 93.0% and 100%, whereas graft survival was 83.4% and 92.3%, respectively. The 16 children in the ABO-I group received a total of 18 liver allografts. Four patients received an emergent ABO-I liver transplant for primary nonfunction of the first graft. All ABO-I children were alive and well 1 yr after transplantation. One child died 471 days after transplantation in a local emergency room from necrotizing pneumonitis with a functioning graft. Six of the 16 (37.5%) ABO-I allograft children had 8
4 PEDIATRIC ABO LIVER TRANSPLANTATION 975 Figure 1. Comparison of Posttransplant Mean Total Bilirubin between ABO-compatible and ABO-I recipients. Figure 3. Comparison of Posttransplant Mean Alanine Aminotransferase between ABO-compatible and ABO-I recipients. Figure 2. Comparison of Posttransplant Mean Aspartate Aminotransferase between ABO-compatible and ABO-I recipients. rejection episodes, whereas 47 of the 121 (45.1%) children in the in the ABO-compatible group had 121 rejection episodes. The mean time to first rejection in the ABO-I group was days posttransplantation. The mean time to first rejection was days in the ABO-matched group. Liver enzymes for both groups are similar 2 yr after transplant (Figs. 1-3 Antibody titers were recorded only in the presence of irregular antibodies. Other than 1 patient who received plasmapheresis, there were no significantly increased anti-b titers within the ABO-I group (Fig. 4). The anti-a titers of those in the ABO-I group can be found in Figure 5. The anti-a titers show only minor variations within the ABO-I group and did not require intervention. Patient Synopsis The patients presented here are summarized in Table 4. Patient #1 (patient age: 0.75 yr; patient weight: 5kg; Figure 4. Anti-B titer values in Patient #3 pre- and postplasmapheresis. reason for transplant: primary nonfunction), after a successful liver transplant, presented to a local emergency department 471 days later in full cardiac arrest secondary to necrotizing streptococcal pneumonia with septicemia and died with a functioning graft. Patient #2 (17.5 yr, 87 kg, acute fulminate hepatic failure) had 1 episode of rejection confirmed by liver biopsy on postoperative day 41. Patient #3 (13 yr, 55 kg, primary nonfunction) had anti-b titers of 1:32 or less immediately posttransplantation. The patient s anti-b titer increased to 1:1,024 with hemolysis between day 5 and 6 and peaked at day 8 (1:4,096) with concomitant bilirubin at 8.4 milligrams/deciliter (mg/dl), aspartate aminotransferase of 180 Unit/Liter (U/L), alanine aminotransferase of 377 U/L, and gamma glutamyl transpeptidase of 245 U/L even after 1 gm of solumedrol IV on days 5 and 6. The direct antiglobulin test was positive. Plasmapheresis
5 976 HEFFRON ET AL. Figure 5. Pre- and Post-transplant Anti-A titers for ABO-I group. Four patients had immeasurable titers. was started on day 8 at 80% of total blood volume with resultant decrease in bilirubin to 5.7, aspartate aminotransferase to 76, alanine aminotransferase to 82, and gamma glutamyl transpeptidase to 98. A 4-fold increase in anti-b titers was noted, resulting in an increased total volume exchange to 150% starting on day 12. By day 17 all lab values had returned to normal and plasmapheresis was stopped. By day 21 the anti-b titer was 1:32 and bilirubin was 0.9, with complete resolution of the hemolysis. This patient had 2 biopsy-proven episodes of acute cellular rejection at 95 and 169 days posttransplantation, which were responsive to pulsed intravenous steroids (Fig. 4). Patient #4 (16.8 yr, 55 kg, subacute hepatic necrosis) was released from the hospital without complications and has had no additional problems. Patient #5 (14.0 yr, 51 kg, autoimmune) received a total of 3 transplants. This child s first ABO-matched transplant was lost to sepsis; the second allograft was an ABO-I allograft and was lost on postoperative day 19 due to complications following a percutaneous transhepatic cholangiogram. This patient was retransplanted with an ABO-compatible liver. Patient #6 (4.3 yr, 23 kg, acute fulminate hepatic failure) received steroid boluses for increased ABO-B antibody titers of 1:512 on postoperative days and increased total bilirubin from 2.4 to 6.8 mg/dl. This patient responded well to intravenous steroids and did not require plasmapheresis. Patient #7 (1.4 yr, 10 kg, hemangioendothelioma) received an ABO-I allograft for primary nonfunction. This child had 1 rejection on postoperative day 311 and responded to intravenous steroids. Patient #8 (2 yr, 12.5 kg, acute fulminate hepatic failure) received a left-lateral segment from a living donor. This patient required a percutaneous transhepatic cholangiogram with biliary stent for stricture. Patient #9 (13.8 yr, 42.4 kg, acute fulminate hepatic failure) was released from the hospital without hepatic complications. Patient #10 (5.0 yr, 15.2 kg, Alagille syndrome) electively received an AB liver that would not have been used as there was no match nationally and it was turned down by all other centers. On postoperative day 98, the patient was diagnosed with clinical rejection, which was treated by increasing immunosuppression and 1 dose of intravenous steroids. Biopsy revealed mild rejection on postoperative day 197, which was successfully treated with 2 doses of intravenous steroids; the patient was discharged from the hospital. Patient #11 (0.5 yr, 6.3 kg, decompensated biliary atresia) was released from the hospital without complications and has had no interval hepatic complications. Patient #12 (0.35 yr, 6.3 kg, decompensated biliary atresia) was released from the hospital without complications and has had no additional problems. Patient #13 (0.25 yr, 5.66 kg, congenital cirrhosis) was released from the hospital without complications and has had no additional problems. Patient #14 (0.88 yr, 8.0 kg, biliary atresia) received her second allograft after her first liver decompensated on postoperative day 10. She was released from the hospital and has had no interval hepatic complications. Patient #15 (1.92 yr, 11.9 kg, biliary atresia) was released from the hospital without complications and has had no additional problems. Patient #16 (17.58 yr, 47.0 kg, acute fulminate hepatic failure due to hepatitis B) developed a bile duct stricture on postoperative day 15. The patient required a biliary stent, but otherwise has been without acute cellular rejection to date. DISCUSSION Many surgical and medical advances over the last 3 decades have dramatically improved patient and graft survival for children with end-stage liver disease requiring liver transplantation. However, recipient need for organs has outpaced donor availability and split livers have been underutilized in the United States. Historically, ABO-I grafts have been limited to emergency situations and have resulted in inferior patient and graft survival compared to ABO-compatible grafts. In 1986, Gordon et al. 8 reported decreased patient (45%) and graft (26%) survival for ABO-I liver transplants at 1 yr. In 1990, Gugenheim et al. 9 published a series of 234 liver transplants in which the 2-yr survival was 76% for ABO-compatible grafts and 30% for ABO-I grafts. He noted an increased incidence of biliary complications and vascular thrombosis as well as histological findings compatible with antibody mediated rejection. In 1995, Farges et al. 4,5 reported greatly decreased patient and graft survival with increased incidence of rejection and biliary and vascular complications in the ABO-I group. In a large series Bjoro et al. 10 found that patients who received an ABO-I liver had a much poorer graft survival rate (40 vs. 64% for ABO-compatible grafts) at 1 yr. Most recently, various groups have attempted to use
6 PEDIATRIC ABO LIVER TRANSPLANTATION 977 TABLE 4. ABO-I Patient Outcomes Age (yr) Gender Primary diagnosis UNOS status Transplant type Donor ABO Recipient ABO Complication Status F Biliary atresia; 1 LLS B A Died-sepsis PNF # M FHF 1 Whole A B Rejection Alive 3 13 F PNC; PNF #2 1 Whole B A Rejection Alive M PNC 1 Whole A O Alive 5 14 M PNC 1 Whole A B Hema Alive M FHF 1 LLS A O Alive M Tumor; PNF#2 1 LLS A O Rejection Alive 8 2 M FHF 1 LR-LLS B A Biliary stricture Alive F FHF 1 Whole B A Alive 10 5 F Alagille syndrome PELD score 6 Whole AB A Rejection Alive F Biliary atresia 1 Whole A O Alive F Biliary atresia 1 LLS A O Alive F Congenital 1 Whole AB A Alive cirrhosis F Biliary atresia; 1 LLS AB A Alive PNF # F Biliary atresia 1 LL A O Alive M FHF; Hepatitis B 1 Whole A O Biliary stricture Alive Abbreviations: LLS, left lateral segment; LL, left lobe; Hema, graft loss secondary to hematoma from invasive procedure; PNF, primary nonfunction; FHF, fulminant hepatic failure; PNC, postnecrotic cirrhosis. plasmapheresis, splenectomy, and novel immunosuppression regimens in an attempt to improve graft survival when crossing blood groups. Hanto et al. (2003) reported one and 5 yr patient and graft survival rates of 71.4% and 61.2%, respectively, in 14 adult patients, using a regimen of total plasma exchange, splenectomy and quadruple immunosuppression. Stegall 11 comments on the importance of this approach, with the lack of humoral rejection despite high anti-blood group titers and suggests extending this option to recipients with cancer or long wait times. In addition, he states that ABO-I liver transplantation leads to long-term graft loss secondary to vascular thrombosis and biliary complications. 11 In pediatric recipients, results in ABO-I liver transplantation have been mixed. Egawa et al. 2 notes that children less than 1 yr of age survive significantly longer with significantly less biliary complications than those greater than 1 yr of age. Morbidity and mortality appear to increase with age. As early as 1999, Varela- Fascinetto et al. 12 reported no significant difference in 10-yr patient or graft survival in children receiving 28 ABO-I grafts compared with those receiving 72 ABOcompatible or identical grafts. In addition, rejection, vascular thrombosis, and biliary complications were not significantly different. While 1 of 3 of those receiving an ABO-I graft had transient increases in antibody titers, only 3 of the 28 grafts required treatment. As recently as 2003, Szymczak et al. 13 reported decreased pediatric 1-yr patient and graft survival of 57% associated with increased late acute and chronic rejection in ABO-I grafts. In 1994, Tanaka et al. 14 reported 13 ABO-I pediatric liver transplants from living-related donors (mother or father) with preoperative plasmapheresis. Posttransplantation plasmapheresis was reserved for isoagglutinin titers greater than 64. A 77% patient and graft survival resulted with 3 of 13 patients dying from portal vein thrombosis, sepsis, and graft dysfunction. Takayma et al. 15 reported 3 cases of pediatric ABO-I liver transplantation with patient and graft survival of 100% at 1 yr. In our series, we used our standard immunosuppressive protocol without preoperative plasmapheresis or splenectomy. Despite a high percentage of higher-risk older age pediatric group (6/16 were older than 13 yr of age while 3/16 were older than 16 yr of age), a 1-yr actuarial patient survival of 100% and graft survival of 83% was achieved. The sole graft loss was secondary to intrahepatic hemorrhage after a percutaneous transhepatic cholangiogram that did not reveal a biliary stricture or leak. The sole patient loss was due to necrotizing pneumonitis 471 days after liver transplant. The patient died with a functioning graft. Hemolysis, responsive to plasmapheresis has been reported after solid organ transplantation. 16,17 In our series, the 1 patient with hemolysis that required plasmapheresis had an increased anti-b titer in the absence of measurable anti-a titer (Fig. 4), a positive direct antiglobulin test with clinical evidence of rejection, and high bilirubin. This was the only patient with high preformed antibodies prior to transplantation. Few mechanisms might be responsible for this immunemediated hemolysis: preformed antibodies, antibodies derived from donor passenger lymphocytes, or an associated minor mismatch type of immune reaction. 18 The complexity of posttransplantation hemolytic reactions is beyond the scope of this article. Of note, other than 2 bouts of rejection, this patient is alive and well with
7 978 HEFFRON ET AL. normal liver function tests more than 5 yr after transplant. We believe that interleukin-2 blockade with monoclonal antibodies (through CD25) may provide modulation of activated T and B cells early after transplantation and allow starting calcineurin inhibitors after increasingly longer intervals. However, we do not feel that this is as potent an immunosuppressive regimen compared to that reported that by other groups with less favorable results. Our study is at a later time frame than previous studies in these small, technically challenging patients. Many of the poor results previously attributed to crossing blood groups may have been secondary to the poor condition of the recipient and the increased incidence of vascular and biliary complications in this earlier time frame. Biliary and vascular complications have decreased in centers with experience. 14,19,20 Recently Kim et al. 21 have reported improved survival in children. Of importance, 100% survival at 1 yr, even in small patient groups of 16 children is better than the 93% survival reported in our larger patient group of ABO-compatible recipients. Limitations of this study include the relatively small number of patients and the difficulty of analyzing liver transplantation based on perioperative isohemagglutinin titer. Liver allografts are thought to be more resistant to immunological attacks and may actually provide a protective effect against antibody-mediated response. This may make the sole anti-ab titers more difficult to interpret. Moreover, presence of humoral rejection was not evaluated. In our experience, pediatric recipient patients with ABO-I grafts have long-term outcomes comparable or superior (100%) with ABO-compatible grafts (93%) without any difference in rejection or in vascular or biliary complications. Unlike other reports, recipient age did not appear to impact patient or graft survival. We have achieved optimal outcomes without modifying our standard immunosuppressive protocol and without preoperative plasmapheresis or perioperative splenectomy. Crossing blood groups has played a significant role in avoiding pediatric waitlist mortality in emergent patients at our center. This supports the concept of using ABO-I grafts in an elective setting associated with split and living donor liver transplants. Further studies are necessary to confirm our conclusions. REFERENCES 1. Rydberg L. ABO-incompatibility in solid organ transplantation. Transfus Med 2001;11: Egawa H, Oike F, Buhler L, Shapiro AM, Minamiguchi S, Haga H, et al. Impact of recipient age on outcome of ABOincompatible living-donor liver transplantation. Transplantation 2004;77: Fang WC, Saltzman J, Rososhansky S, Szabo G, Heard SO, Banner B, et al. Acceptance on an ABO-incompatible mismatched (AB to 0) liver allograft with the use of Dacluzamib and mycophenolate mofetil. Liver Transpl 2000; 6: Farges O, Kalil AN, Samuel D, Saliba F, Arulnaden JL, Debat P, et al. The use of ABO-incompatible grafts in liver transplantation: A life-saving procedure in highly selected patients. Transplantation 1995;59: Farges O, Nocci Kalil A, Samuel D, Arulnaden JL, Bismuth A, Castaing D, et al. Long-term results of ABO-incompatible liver transplantation. Transplant Proc 1995;27: Hanto D, Fecteasu A, Alonso M, Valente JF, Whiting JF. ABO-Incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation. Liver Transpl 2003;9: Monteiro I, McLaughlin L, Fisher A, de la Torre AN, Koneru B. Rituximab with plasmapheresis and splenectomy in ABOincompatible liver transplantation. Transplantation 2003; 76: Gordon RD, Iwatsuki S, Esquivel CO, Tzakis A, Todo S, Starzl TE. Liver transplantation across ABO blood groups. Surgery 1986;100: Gugenheim J, Samuel D, Reynes M, Bismuth H. Liver transplantation across ABO blood group barriers. Lancet 1990;336: Bjoro K, Ericzon B, Kirkegaard P. highly urgent liver transplantation: possible impact of donor-recipient ABO matching on the outcome after transplantation. Transplantation 2003;75: Stegall M. ABO-incompatible liver transplant: is it justifiable? Liver Transpl 2003;9: Varela-Fascinetto G, Treacy SJ, Lillehei CW, Jonas MM, Lund DP, Kevy SV, et al. Long-term results in pediatric ABOincompatible liver, Transplant Proc 1999;31: Szymczak M, Kalicinski P, Kaminski A, Ismail H, Drewniak T, Nachulewicz P, et al. Liver transplantation across ABO blood groups in children. Transplant Proc 2003;35: Tanaka A, Tanaka K, Kitai T, Yanabu N, Tokuka A, Sato B, et al. Living related liver transplantation across ABO blood groups. Transplantation 1994;58: Takayama J, Ohkohchi N, Oikawa K, Asakura T, Kawagishi N, Kikuchi H, et al. Living related liver transplantation in patients with ABO incompatibility. Transplant Proc 1998;30: Gregoire JR. Immune hemolytic anemia after renal transplantation secondary to ABO-minor mismatch between the donor and recipient. J Am Soc Nephrol 1993;4: Hareuveni M, Merchav H, Austerlitz N, Rahimi-Levene N, Ben-Tal O. Donor anti-jk causing hemolysis in a liver transplant recipient. Transfusion 2002;42: Panaro F, DeChristopher PJ, Rondelli D, Testa G, Sankary H, Popescu M, et al. Severe hemolytic anemia due to passenger lymphocytes after living-related small bowel transplant (Case Report). Clin Transplant 2004;18: Heffron TG, Welch D, Pillen T, Fasola C, Redd D, Smallwood GA, et al. Low incidence of hepatic artery thrombosis after pediatric liver transplantation without the use of intraoperative microscope or parenteral anticoagulation. Pediatr Transplant 2005;9: Guarrera JV, Sinha P, Lobritto SJ, Brown RS Jr, Kinkhabwala M, Emond JC. Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe. Transpl Int 2004;17: Kim JS, Groteluschen R, Mueller T, Ganschow R, Bicak T, Wilms C. Pediatric transplantation: the Hamburg experience. Transplantation 2005;79:
Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation
LIVER TRANSPLANTATION 12:1210-1214, 2006 ORIGINAL ARTICLE Induction Immunosuppression With Rabbit Antithymocyte Globulin in Pediatric Liver Transplantation Ashesh Shah, 1 Avinash Agarwal, 1 Richard Mangus,
More informationFigure 1. Actuarial survival of patients with ABO I, ABO compatible, and ABO identical grafts.
New Insights into Antibody Mediated Graft Injury after Pediatric Liver Transplantation S.V. McDiarmid MD Professor of Pediatrics and Surgery David Geffen School of Medicine University of California, Los
More informationLIVER TRANSPLANTATION
LIVER TRANSPLANTATION Selection 0 / Patients and Results Late Mortality and Morbidity After Liver Transplantation S. Iatsuki. T.E. Starzl. R.D. Gordon, C.O. Esquivel. S. Todo, A.G. Tzakis, L. Makoka. J.W.
More informationDesensitization in Kidney Transplant. James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver
Desensitization in Kidney Transplant James Cooper, MD Assistant Professor, Kidney and Pancreas Transplant Program, Renal Division, UC Denver Organ Shortage Currently there are >90,000 patients on the kidney
More informationSerum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant
SDC, Patients and Methods Complement-dependent lymphocytotoxic crossmatch test () Serum samples from recipients were obtained within 48 hours before transplantation. Pre-transplant donor-specific CXM was
More informationLiver Transplantation
1 Liver Transplantation Department of Surgery Yonsei University Wonju College of Medicine Kim Myoung Soo M.D. ysms91@wonju.yonsei.ac.kr http://gs.yonsei.ac.kr History Development of Liver transplantation
More informationLiving Related Liver Transplantation for Acute Liver Failure in Children
ORIGINAL ARTICLES Living Related Liver Transplantation for Acute Liver Failure in Children Sukru Emre, Myron E. Schwartz, Benjamin Shneider, Joanne Hojsak, Leona Kim-Schluger, Thomas M. Fishbein, Stephen
More informationOutcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis
Submit a Manuscript: http://www.f6publishing.com DOI: 10.3748/wjg.v23.i35.6516 World J Gastroenterol 2017 September 21; 23(35): 6516-6533 ISSN 1007-9327 (print) ISSN 2219-2840 (online) META-ANALYSIS Outcomes
More informationTransplant in Pediatric Heart Failure
Transplant in Pediatric Heart Failure Francis Fynn-Thompson, MD Co-Director, Center for Airway Disorders Surgical Director, Pediatric Mechanical Support Program Surgical Director, Heart and Lung Transplantation
More informationLiver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience
Liver Transplantation for Biliary Atresia: 19-Year, Single-Center Experience L Thomas Chin 1, Anthony M D Alessandro 1, Stuart J Knechtle 1, Luis A Fernandez 1, Glen Leverson 1, Robert H Judd 2, Elizabeth
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2014 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE II TRANSPLANTATION Section
More informationLiver Transplantation in Children: Techniques and What the Surgeon Wants to Know from Imaging
Liver Transplantation in Children: Techniques and What the Surgeon Wants to Know from Imaging Jaimie D. Nathan, MD Associate Professor of Surgery and Pediatrics Associate Surgical Director, Liver Transplant
More informationLIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES
LIVER TRANSPLANTATION FOR OVERLAP SYNDROMES OF AUTOIMMUNE LIVER DISEASES No conflict of interest Objectives Introduction Methods Results Conclusions Objectives Introduction Methods Results Conclusions
More informationLive Donor Liver Transplantation: A Life Saving Option for End Stage Liver Disease
Live Donor Liver Transplantation: A Life Saving Option for End Stage Liver Disease Abhi Humar, MD Clinical Director, Thomas E. Starzl Transplantation Institute 1 PITTSBURGH THE BIRTHPLACE OF LIVER TRANSPLANTATION
More informationNAPRTCS Annual Transplant Report
North American Pediatric Renal Trials and Collaborative Studies NAPRTCS 2010 Annual Transplant Report This is a privileged communication not for publication. TABLE OF CONTENTS PAGE I INTRODUCTION 1 II
More informationFeasible usage of ABO incompatible grafts in living donor liver transplantation
Original Article Feasible usage of ABO incompatible grafts in living donor liver transplantation Toru Ikegami, Tomoharu Yoshizumi, Yuji Soejima, Hideaki Uchiyama, Ken Shirabe, Yoshihiko Maehara Department
More informationWithdrawal of Immunosuppression in Pediatric Liver Transplant Recipients in Korea
Original Article DOI 10.3349/ymj.2009.50.6.784 pissn: 0513-5796, eissn: 1976-2437 Yonsei Med J 50(6): 784-788, 2009 Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients in Korea Jee
More informationABO INCOMPATILIBITY AND TRANSPLANTATION
ABO INCOMPATILIBITY AND TRANSPLANTATION Aleksandar Mijovic Consultant Haematologist/Senior Lecturer King s College Hospital/NHS Blood and Transplant London, UK RTC Edu Meeting May 2017 ABO antigens Expressed
More informationPediatric Liver Transplantation Outcomes in Korea
ORIGINAL ARTICLE Cell Therapy & Organ Transplantation http://dx.doi.org/6/jkms.8..4 J Korean Med Sci 0; 8: 4-47 Pediatric Liver Transplantation Outcomes in Korea Jong Man Kim,, * Kyung Mo Kim,, * Nam-Joon
More informationSteroid-Resistant Acute Rejections After Liver Transplant
ARTICLE Steroid-Resistant Acute Rejections After Liver Transplant Cem Aydogan, 1 Sinasi Sevmis, 1 Sema Aktas, 1 Hamdi Karakayali, 1 Beyhan Demirhan, 2 Mehmet Haberal 1 Abstract Objectives: Liver transplant
More informationSINCE the introduction of Imuran and
Cadaveric Renal Transplantation With Cyclosporin-A and Steroids T. R. Hakala, T. E. Starzl, J. T. Rosenthal, B. Shaw, and S. watsuki SNCE the introduction of muran and prednisone in 1961, and despite the
More informationORIGINAL ARTICLE. Received April 30, 2007; accepted June
LIVER TRANSPLANTATION 13:1405-1413, 2007 ORIGINAL ARTICLE Human Leukocyte Antigen and Adult Living- Donor Liver Transplantation Outcomes: An Analysis of the Organ Procurement and Transplantation Network
More informationWhat Is the Real Gain After Liver Transplantation?
LIVER TRANSPLANTATION 15:S1-S5, 9 AASLD/ILTS SYLLABUS What Is the Real Gain After Liver Transplantation? James Neuberger Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, United Kingdom;
More informationLive Donor Small Bowel Transplantation. Enrico Benedetti, MD, FACS Warren H. Cole Chair in Surgery Professor and Head Department of Surgery
Live Donor Small Bowel Transplantation Enrico Benedetti, MD, FACS Warren H. Cole Chair in Surgery Professor and Head Department of Surgery INTESTINAL TRANSPLANTATION: A RELATIVE RARE PROCEDURE In 2017
More informationNONSPECIFIC Starts in the blood by
BASIC IMMUNOLOGY and ORGAN TRANSPLANTATION Ahmed Mahmoud,MD Host defense against infection is 1- nonspecific or 2- specific (immune system) NONSPECIFIC Starts in the blood by 1) leucocytes phagocytosis
More informationPOST TRANSPLANT OUTCOMES IN PSC
POST TRANSPLANT OUTCOMES IN PSC Kidist K. Yimam, MD Medical Director, Autoimmune Liver Disease Program Division of Hepatology and Liver Transplantation California Pacific Medical Center (CPMC) PSC Partners
More informationSerum Cholesterol Changes in Long-Term Survivors of Liver Transplantation: A Comparison Between Cyclosporine and Tacrolimus Therapy
Serum Cholesterol Changes in Long-Term Survivors of Liver Transplantation: A Comparison Between Cyclosporine and Tacrolimus Therapy Ramón Charco,* Carme Cantarell, Victor Vargas,* Luis Capdevila, Jose
More informationSELECTED ABSTRACTS. All (n) % 3-year GS 88% 82% 86% 85% 88% 80% % 3-year DC-GS 95% 87% 94% 89% 96% 80%
SELECTED ABSTRACTS The following are summaries of selected posters presented at the American Transplant Congress on May 5 9, 2007, in San Humar A, Gillingham KJ, Payne WD, et al. Review of >1000 kidney
More informationDonor Hypernatremia Influences Outcomes Following Pediatric Liver Transplantation
8 Original Article Donor Hypernatremia Influences Outcomes Following Pediatric Liver Transplantation Neema Kaseje 1 Samuel Lüthold 2 Gilles Mentha 3 Christian Toso 3 Dominique Belli 2 Valérie McLin 2 Barbara
More informationEuropean Risk Management Plan. Measures impairment. Retreatment after Discontinuation
European Risk Management Plan Table 6.1.4-1: Safety Concern 55024.1 Summary of Risk Minimization Measures Routine Risk Minimization Measures Additional Risk Minimization Measures impairment. Retreatment
More information/03/ /0 TRANSPLANTATION Vol. 75, , No. 7, April 15, 2003 Copyright 2003 by Lippincott Williams & Wilkins, Inc.
0041-1337/03/7507-1020/0 TRANSPLANTATION Vol. 75, 1020 1025, No. 7, April 15, 2003 Copyright 2003 by Lippincott Williams & Wilkins, Inc. Printed in U.S.A. THE ABSENCE OF CHRONIC REJECTION IN PEDIATRIC
More informationABO. ABO ABO ABO ABO ABO ABO ABO ABO. Key words ABO. Alexandre ABO ABO. double filtration plasmapheresis, DFPP. antibody-mediated rejection, AMR
ABO ABO ABO ABO ABO ABO ABO ABO ABO ABO.. ABO ABO. ABO. ABO ABO Key words ABO ABO A B antibody-mediated rejection, AMR Alexandre ABO double filtration plasmapheresis, DFPP ABO ABO n ABO n p-value R.....
More informationAMR in Liver Transplantation: Incidence
AMR in Liver Transplantation: Incidence Primary AMR 1/3 to 1/2 of ABO-incompatible transplants Uncommon with ABO-compatible transplant Secondary AMR Unknown incidence: rarely tested Why is AMR uncommon
More informationSolid organ transplantation is a major achievement of. Liver Transplantation: Current Status and Novel Approaches to Liver Replacement
GASTROENTEROLOGY 2001;120:749 762 Liver Transplantation: Current Status and Novel Approaches to Liver Replacement EMMET B. KEEFFE Division of Gastroenterology and Hepatology, Department of Medicine, Stanford
More informationInformation for patients (and their families) waiting for liver transplantation
Information for patients (and their families) waiting for liver transplantation Waiting list? What is liver transplant? Postoperative conditions? Ver.: 5/2017 1 What is a liver transplant? Liver transplantation
More informationExperience in 1,000 Liver Transplants Under Cyclosporine-Steroid Therapy: A Survival Report
Experience in 1,000 Liver Transplants Under Cyclosporine-Steroid Therapy: A Survival Report S. watsuki. T.E. Starzl, S. Todo, R.D. Gordon, C.O. Esquivel, A.G. Tzakis, L. Makowka, J.W. Marsh, B. Koneru,
More informationOverall Goals and Objectives for Transplant Hepatology EPAs:
Overall Goals and Objectives for Transplant Hepatology EPAs: 1. DIAGNOSTIC LIST During the one-year Advanced Pediatric Transplant Hepatology Program, fellows are expected to develop comprehensive skills
More informationLiver Transplant for Fulminant Hepatic Failure: A Single-Center Experience
ARTiCle Liver Transplant for Fulminant Hepatic Failure: A Single-Center Experience Mahir Kirnap, 1 Aydincan Akdur, 1 Figen Ozcay, 2 Ebru Soy, 1 Sedat Yildirim, 1 Gokhan Moray, 1 Mehmet Haberal 1 Abstract
More informationHistopathology of De Novo Autoimmune Hepatitis
LIVER TRANSPLANTATION 18:811-818, 2012 ORIGINAL ARTICLE Histopathology of De Novo Autoimmune Hepatitis Ananya Pongpaibul, 1 Robert S. Venick, 2 Sue V. McDiarmid, 3 and Charles R. Lassman 4 1 Department
More informationHepatic Artery Reconstruction in Living Donor Liver Transplant Experience at King Hussein Medical Center
Hepatic Artery Reconstruction in Living Donor Liver Transplant Experience at King Hussein Medical Center Khaldoun J. Haddadin MD FRCS (Eng)*, Nasser Q. Ahmad MD MRCSI*, Abdelhamid M. Aladwan MD ** ABSTRACT
More informationOutcomes and Risk Factors for Failure of Radiologic Treatment of Biliary Strictures in Pediatric Liver Transplantation Recipients
LIVER TRANSPLANTATION 12:821-826, 2006 ORIGINAL ARTICLE Outcomes and Risk Factors for Failure of Radiologic Treatment of Biliary Strictures in Pediatric Liver Transplantation Recipients Bhanu Sunku, 1
More informationSignificant allograft dysfunction after liver transplantation
Bile Duct Strictures After Adult Liver Transplantation: A Role for Biliary Reconstructive Surgery? Robert Sutcliffe, 1 Donal Maguire, 1 Andrej Mróz, 2 Bernard Portmann, 1 John O Grady, 1 Matthew Bowles,
More informationABO-incompatible kidney transplantation in elderly patients over 60 years of age
Int Urol Nephrol (2012) 44:1563 1570 DOI 10.1007/s11255-012-0231-z NEPHROLOGY - ORIGINAL PAPER ABO-incompatible kidney transplantation in elderly patients over 60 years of age Junji Uchida Tomoaki Iwai
More informationIncreased Early Rejection Rate after Conversion from Tacrolimus in Kidney and Pancreas Transplantation
Increased Early Rejection Rate after Conversion from Tacrolimus in Kidney and Pancreas Transplantation Gary W Barone 1, Beverley L Ketel 1, Sameh R Abul-Ezz 2, Meredith L Lightfoot 1 1 Department of Surgery
More informationSolid Organ Transplantation 1. Chapter 55. Solid Organ Transplant, Self-Assessment Questions
Solid Organ Transplantation 1 Chapter 55. Solid Organ Transplant, Self-Assessment Questions Questions 1 to 9 are related to the following case: A 38-year-old white man is scheduled to receive a living-unrelated
More informationHLA and Non-HLA Antibodies in Transplantation and their Management
HLA and Non-HLA Antibodies in Transplantation and their Management Luca Dello Strologo October 29 th, 2016 Hystory I 1960 donor specific antibodies (DSA): first suggestion for a possible role in deteriorating
More informationTransplant Hepatology
Transplant Hepatology Certification Examination Blueprint Purpose of the exam The exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified
More informationStrategies for Desensitization
Strategies for Desensitization Olwyn Johnston MB, MRCPI, MD, MHSc BC Nephrology Day October 8 th 2010 Pre-transplant crossmatch (CMX) with donor lymphocytes has been standard of practice Positive CDC CXM
More informationORIGINAL ARTICLE. Summary
Transplant International ISSN 0934-0874 ORIGINAL ARTICLE Thrombotic and nonthrombotic hepatic artery complications in adults and children following primary liver transplantation with long-term follow-up
More informationChapter 6: Transplantation
Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.
More informationABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study M. Mendes, A.C. Ferreira, A. Ferreira, F. Remédio, I. Aires, A. Cordeiro, A. Mascarenhas, A. Martins, P.
More informationThe Incidence, Timing, and Management of Biliary Tract Complications After Orthotopic Liver Transplantation
A:"
More informationIn-Hospital Mortality in Adult Recipients of Living Donor Liver Transplantation: Experience of 576 Consecutive Cases at a Single Center
LIVER TRANSPLANTATION 15:1420-1425, 2009 ORIGINAL ARTICLE In-Hospital Mortality in Adult Recipients of Living Donor Liver Transplantation: Experience of 576 Consecutive Cases at a Single Center Toshimi
More informationUse of mycophenolate mofetil in steroid-dependent and -resistant nephrotic syndrome
Pediatr Nephrol (2003) 18:833 837 DOI 10.1007/s00467-003-1175-4 BRIEF REPORT Gina-Marie Barletta William E. Smoyer Timothy E. Bunchman Joseph T. Flynn David B. Kershaw Use of mycophenolate mofetil in steroid-dependent
More informationSingle-Center Experience and Long-Term Outcomes of Duct-to-Duct Biliary Reconstruction in Infantile Living Donor Liver Transplantation
LIVER TRANSPLANTATION 20:347 354, 2014 ORIGINAL ARTICLE Single-Center Experience and Long-Term Outcomes of Duct-to-Duct Biliary Reconstruction in Infantile Living Donor Liver Transplantation Hidekazu Yamamoto,
More informationImmunosuppressants. Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia
Immunosuppressants Assistant Prof. Dr. Najlaa Saadi PhD Pharmacology Faculty of Pharmacy University of Philadelphia Immunosuppressive Agents Very useful in minimizing the occurrence of exaggerated or inappropriate
More informationI topic liver transplantation (OLT) to avoid organ
ORIGINAL ARTICLES Long-Term Immunosuppression Without Corticosteroids After Orthotopic Liver Transplantation: A Positive Therapeutic Aim Gerald M. Fraser, * Kons tantinos Grammous tianos, Jayendravandan
More informationBASIC IMMUNOLOGY and ORGAN TRANSPLANTATION. Ahmed Mahmoud,MD
BASIC IMMUNOLOGY and ORGAN TRANSPLANTATION Ahmed Mahmoud,MD Host defense against infection is 1-nonspecific or 2-specific (immune system) NONSPECIFIC Starts in the blood by 1) leucocytes phagocytosis and
More informationPost-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies
Post-Transplant Monitoring for the Development of Anti-Donor HLA Antibodies Lorita M Rebellato, Ph.D., D (ABHI) Associate Professor Department of Pathology The Brody School of Medicine at ECU Scientific
More informationPathology s Role in Liver Transplantation Surgery: Offering Patients a New Lease on Life
Pathology s Role in Liver Transplantation Surgery: Offering Patients a New Lease on Life Montefiore recently became the first health system in New York City to perform a liver transplant using a donor
More informationBILIARY TRACT COMPLICATIONS IN HUMAN ORTHOTOPIC LIVER TRANSPLANTATION 1,2
004-33/8/430-004$02.00/0 TRANSPLANTATION Copyright (c) 98 by The Williams & Wilkins Co. Vol. 43, No. Printed in U.S.A. BILIARY TRACT COMPLICATIONS IN HUMAN ORTHOTOPIC LIVER TRANSPLANTATION,2 JAN LERUT,
More informationAutoimmune Hepatobiliary Diseases PROF. DR. SABEHA ALBAYATI CABM,FRCP
Autoimmune Hepatobiliary Diseases PROF. DR. SABEHA ALBAYATI CABM,FRCP Autoimmune hepatobiliary diseases The liver is an important target for immunemediated injury. Three disease phenotypes are recognized:
More informationPancreas After Islet Transplantation: A First Report of the International Pancreas Transplant Registry
American Journal of Transplantation 2016; 16: 688 693 Wiley Periodicals Inc. Brief Communication Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi:
More informationDoes the Banff Rejection Activity Index Predict Outcome in Patients With Early Acute Cellular Rejection Following Liver Transplantation?
LIVER TRANSPLANTATION 12:1144-1151, 2006 ORIGINAL ARTICLE Does the Banff Rejection Activity Index Predict Outcome in Patients With Early Acute Cellular Rejection Following Liver Transplantation? Barbara
More informationExtensive Use of Split Liver for Pediatric Liver Transplantation: A Single-Center Experience
ORIGINAL ARTICLES Extensive Use of Split Liver for Pediatric Liver Transplantation: A Single-Center Experience Marco Spada, Bruno Gridelli, Michele Colledan, Andrea Segalin, Alessandro Lucianetti, Wanda
More informationReview of Rituximab and renal transplantation. Dr.E Nemati. Professor of Nephrology
Review of Rituximab and renal transplantation Dr.E Nemati Professor of Nephrology Introductio n Rituximab is a chimeric anti-cd20 monoclonal antibody. The CD20 antigen is a transmembrane nonglycosylated
More informationTIAN AND OTHERS common hepatic artery. For LDLT, a microvascular technique was employed to anastomose the donor artery to either the right or left hep
Original Article Treatment of Hepatic Artery Thrombosis After Orthotopic Liver Transplantation Ming Guo Tian, Wai Kuen Tso, 1 Chung Mau Lo, Chi Leung Liu and Sheung Tat Fan, Departments of Surgery and
More informationVascular Imaging in the Pediatric Abdomen. Jonathan Swanson, MD
Vascular Imaging in the Pediatric Abdomen Jonathan Swanson, MD Goals and Objectives To understand the imaging approach, appearance, and clinical manifestations of the common pediatric abdominal vascular
More informationCase-Control Study: ABO-Incompatible Plasma Causing Hepatic Veno-Occlusive Disease in HSCT
Case-Control Study: ABO-Incompatible Plasma Causing Hepatic Veno-Occlusive Disease in HSCT Erin Meyer, DO, MPH Assistant Medical Director of Blood, Tissue, and Apheresis Services Children s Healthcare
More informationCyclosporine A Withdrawal during Follow-Up After Pediatric Liver Transplantation
LIVER TRANSPLANTATION 12:240-246, 2006 ORIGINAL ARTICLE Cyclosporine A Withdrawal during Follow-Up After Pediatric Liver Transplantation Rene Scheenstra, 1 Maarten L.J. Torringa, 2 Herman J. Waalkens,
More informationAPHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS
APHERESIS FOR DESENSITIZATION OF NON-RENAL TRANSPLANTS GOW AREPALLY, MD MEDICAL DIRECTOR DUKE THERAPEUTIC APHERESIS SERVICE ASSOCIATE PROFESSOR, MEDICINE AMERICAN SOCIETY FOR APHERESIS MAY 25 TH 2013 OVERVIEW
More informationBiliary Reconstruction for Infantile Living Donor Liver Transplantation: Roux-en-Y Hepaticojejunostomy or Duct-to-Duct Choledochocholedochostomy?
LIVER TRANSPLANTATION 14:1761-1765, 2008 ORIGINAL ARTICLE Biliary Reconstruction for Infantile Living Donor Liver Transplantation: Roux-en-Y Hepaticojejunostomy or Duct-to-Duct Choledochocholedochostomy?
More informationLong-Term Outcomes of 600 Living Donor Liver Transplants for Pediatric Patients at a Single Center
LIVER TRANSPLANTATION 12:1326-1336, 2006 ORIGINAL ARTICLE Long-Term Outcomes of 600 Living Donor Liver Transplants for Pediatric Patients at a Single Center Mikiko Ueda, 1 Fumitaka Oike, 1 Yasuhiro Ogura,
More information1. Discuss the basic pathophysiology of end-stage liver and kidney failure.
TRANSPLANT SURGERY ROTATION (PGY1, 2) A. Medical Knowledge Goal: The resident will achieve a detailed knowledge of the evaluation and treatment of a variety of disease processes. The resident will be exposed
More informationResearch Article Anti-HLA and Anti-MICA Antibodies in Liver Transplant Recipients: Effect on Long-Term Graft Survival
Clinical and Developmental Immunology Volume 2013, Article ID 828201, 5 pages http://dx.doi.org/10.1155/2013/828201 Research Article Anti-HLA and Anti-MICA Antibodies in Liver Transplant Recipients: Effect
More informationCombined Liver and Kidney Transplantation with Particular Reference to Positive Cytotoxic Crossmatches
T.E. Starzl. A. Tzakis. L. Makowka. J. Fung. G. Klintmalm. S. Todo. R. Gordon. and M. Griffin 40 Combined Liver and Kidney Transplantation with Particular Reference to Positive Cytotoxic Crossmatches SUMMARY
More informationTransplantation in Australia and New Zealand
Transplantation in Australia and New Zealand Matthew D. Jose MBBS (Adel), FRACP, FASN, PhD (Monash), AFRACMA Professor of Medicine, UTAS Renal Physician, Royal Hobart Hospital Overview CKD in Australia
More informationLiver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995
Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Steven H. Belle, Kimberly C. Beringer, and Katherine M. Detre T he Scientific Liver Transplant Registry (LTR) was established
More informationIntruduction PSI MODE OF ACTION AND PHARMACOKINETICS
Multidisciplinary Insights on Clinical Guidance for the Use of Proliferation Signal Inhibitors in Heart Transplantation Andreas Zuckermann, MD et al. Department of Cardio-Thoracic Surgery, Medical University
More informationThe pediatric end-stage liver disease (PELD) score
Selection of Pediatric Candidates Under the PELD System Sue V. McDiarmid, 1 Robert M. Merion, 2 Dawn M. Dykstra, 2 and Ann M. Harper 3 Key Points 1. The PELD score accurately predicts the 3 month probability
More informationIn the past 15 years the number of kidney
The Role of ABO-Incompatible Living Donors in Kidney Transplantation: State of the Art James Thielke, PharmD,* Bruce Kaplan, MD, and Enrico Benedetti, MD, FACS Summary: In the past, ABO incompatibility
More informationLiver Transplantation
Liver Transplantation Dr Mathew Jacob - MRCS FRCS CCT (UK) Lead Consultant HPB/Transplant Surgeon Aster Integrated Liver Care Program AsterMedcity, kochi, kerala, India mathew@transplantationliver.com
More informationIschemic-type biliary lesions (ITBL) are reported to. Prevention of Ischemic-Type Biliary Lesions by Arterial Back-Table Pressure Perfusion
Prevention of Ischemic-Type Biliary Lesions by Arterial Back-Table Pressure Perfusion Christian Moench, * Kerstin Moench, Ansgar W. Lohse, Jochen Thies, * and Gerd Otto * Ischemic-type biliary lesions
More informationWhy so Sensitive? Desensitizing Protocols for Living Donor Kidney Transplantation
Why so Sensitive? Desensitizing Protocols for Living Donor Kidney Transplantation Stephen J Tomlanovich MD Objectives of this Talk Define the sensitized patient Describe the scope of the problem for a
More informationLiver Transplant: What s Different? Brian Lin, MD, FACEP Emergency Medicine, Kaiser Permanente, San Francisco UCSF Clinical Assistant Professor
Liver Transplant: What s Different? Brian Lin, MD, FACEP Emergency Medicine, Kaiser Permanente, San Francisco UCSF Clinical Assistant Professor No Disclosures. Background 45 years 1998-2008: 90,830 transplants
More informationLiver transplantation (LT) across the ABO bloodtype. Present Status of ABO-Incompatible Living Donor Liver Transplantation in Japan
LIVER FAILURE/CIRRHOSIS/PORTAL HYPERTENSION Present Status of ABO-Incompatible Living Donor Liver Transplantation in Japan Hiroto Egawa, 1 Satoshi Teramukai, 2 Hironori Haga, 1 Minoru Tanabe, 1 Masanori
More informationOne of the most important problems for patients
Selection of Donors and Recipients for Living Donor Liver Transplantation Key Points 1. Living donor liver transplantation (LDLT) is increasingly used for adults with end-stage liver disease. 2. Standards
More informationDonor Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation
Donor Recipient Race Mismatch and Graft Survival After Pediatric Heart Transplantation Kirk R. Kanter, MD, Alexandria M. Berg, MSN, William T. Mahle, MD, Robert N. Vincent, MD, Patrick D. Kilgo, MS, Brian
More informationIsolated Liver Transplantation in Infants with End-Stage Liver Disease Due to Short Bowel Syndrome
LIVER TRANSPLANTATION 12:1062-1066, 2006 ORIGINAL ARTICLE Isolated Liver Transplantation in Infants with End-Stage Liver Disease Due to Short Bowel Syndrome Jean F. Botha, Wendy J. Grant, Clarivet Torres,
More informationSteroid Minimization: Great Idea or Silly Move?
Steroid Minimization: Great Idea or Silly Move? Disclosures I have financial relationship(s) within the last 12 months relevant to my presentation with: Astellas Grants ** Bristol Myers Squibb Grants,
More informationThe Lecture s topics
The Lecture s topics Blood groups -ABO system *Transfusion reaction -Rhesus factor *Hemolytic disease of newborn Blood transfusion and Tissue transplant The ABO System Discovered in 1901 by Dr. Karl Landsteiner
More informationThe first liver transplant in a human was performed
Liver Transplantation With Monosegments. Technical Aspects and Outcome: A Meta-Analysis Marcelo Enne, 1 Lucio Pacheco-Moreira, 1 Elizabeth Balbi, 2 Alexandre Cerqueira, 1 Giuseppe Santalucia, 3 and José
More informationLiving Donor Liver Transplantation NATCO Introductory Course
Living Donor Liver Transplantation NATCO Introductory Course Patricia Harren, RN, ANP, MSN, PNP, CCTC New York Presbyterian Medical Center Center for Liver Disease & Transplant New York, NY Living Donor
More informationOverview of New Approaches to Immunosuppression in Renal Transplantation
Overview of New Approaches to Immunosuppression in Renal Transplantation Ron Shapiro, M.D. Professor of Surgery Surgical Director, Kidney/Pancreas Transplant Program Recanati/Miller Transplantation Institute
More informationManagement of Rejection
Management of Rejection I have no disclosures Disclosures (relevant or otherwise) Deborah B Adey, MD Professor of Medicine University of California, San Francisco Kidney and Pancreas Transplant Center
More informationInfectious Complications in Living-Donor Kidney Transplant Recipients Undergoing Multi-Modal Desensitization
SURGICAL INFECTIONS Volume 15, Number 3, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/sur.2012.231 Surgical Infection Society Articles Infectious Complications in Living-Donor Kidney Transplant Recipients
More informationProgress in Pediatric Kidney Transplantation
Send Orders for Reprints to reprints@benthamscience.net The Open Urology & Nephrology Journal, 214, 7, (Suppl 2: M2) 115-122 115 Progress in Pediatric Kidney Transplantation Jodi M. Smith *,1 and Vikas
More informationPaediatric Liver Transplant Programme Wits Donald Gordon Medical Centre
Paediatric Liver Transplant Programme Wits Donald Gordon Medical Centre J Loveland, J Botha, R Britz, B Strobele, S Rambarran, A Terblanche, C Kock, P Walabh, M Beretta, M Duncan et al 1817 reveal the
More informationVol. 29, pp.585 ~ 589, ml. 1.6 mg/dl 1 MRSA. Table 1 MRI
Vol. 29, pp.585 ~ 589, 2001 8 13 10 22 8 7 1 14 49 26.1 6 2 ABO 7 1 400 800 ml 5 4 10 4 3 3 ABO 3 4 5 5 1 3 4 1 0.8 1.6 mg/dl 1 MRSA 10 7 1 10 7 22 40 8 CYA+ AZ+ MP 3 4 7 GSP 4 1 Table 1 23 1 15 11 5 Alport
More information