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Dinckan A, Eren E, Ensaroglu F, Sahin T, Parlak H, Kocyigit A, Alkara U, Akyildiz M, Tokac M. Paired Exchange Living Donor Liver Transplantation: A Single Center Experience From Turkiye. Transplant Proc 2025; 57:272-276. [PMID: 39648064 DOI: 10.1016/j.transproceed.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 11/11/2024] [Indexed: 12/10/2024]
Abstract
BACKGROUND In countries with low rates of deceased donor solid organ transplantations, live-donor liver transplantation is the preferred definitive treatment for children and adults with end-stage liver disease. However, it is known that a remarkable number of potential living liver donors are rejected due to ABO incompatibility, suboptimal liver mass, or anatomical features. Paired exchange liver transplantation (PELT) practice emerged to overcome these obstacles. Herein, we present the results of our single-center experience with PELT and compare them with previously reported data. METHODS Patients who underwent PELT between January 2015 and December 2022 constituted the target population. The collected recipient data included demographic parameters, the model for end-stage liver disease score, graft-recipient weight ratio, indication for LT and paired exchange, body-mass index, duration of hospital stay, duration of intensive care unit stay, postoperative complications and inpatient mortality. Donor data, including demographic characteristics, body mass index, type of liver graft (right lobe or left lateral segment), graft weight (g), type of portal vein anatomy (Type 1, 2, or 3), type of biliary anatomy (Type 1, 2, 3a, 3b), duration of hospital stay, complications and mortality were retrieved. RESULTS Among 18 recipients, 14 (78%) were male, and 4 (22%) were female. The mean recipient age was 50.7 [2-66], while the mean donor age was 29.3 [18-40]. The mean follow-up period was 31.9 [12-71] months. The 1-year patient and graft survivals were calculated as 83.3% and 88.9%. CONCLUSION The PELT can be utterly feasible at transplant centers with remarkable LDLT experience.
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Affiliation(s)
- Ayhan Dinckan
- Department of General Surgery, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Eryigit Eren
- Department of General Surgery, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Fatih Ensaroglu
- Department of Gastroenterology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Taylan Sahin
- Department of Anesthesiology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Hakan Parlak
- Department of Anesthesiology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Ali Kocyigit
- Department of Radiology, Istinye University Training and Research Hospital, Istanbul, Turkey
| | - Utku Alkara
- Department of Radiology, Yeni Yuzyil Training and Research Hospital, Istanbul, Turkey
| | - Murat Akyildiz
- Department of Gastroenterology, Koc University, School of Medicine, Istanbul, Turkey
| | - Mehmet Tokac
- Department of General Surgery, Istinye University Training and Research Hospital, Istanbul, Turkey.
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Pan Y, Hu J, Li T, Zhang S, Zhou W, Sun J, Wang J, Li W, Xu J. Prior to ABOi liver transplant with PD-1 inhibitor in patients with hepatocellular carcinoma: A case report. Transpl Immunol 2024; 85:102079. [PMID: 38964516 DOI: 10.1016/j.trim.2024.102079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/12/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Liver transplantation (LT) is a unique and effective method for treating end-stage liver diseases and acute liver failure, bringing hope to many patients with liver cancer. LT is currently widely used in the treatment of liver diseases. However, there have been no patients with liver cancer who have undergone ABO-incompatible (ABOi) LT after treatment with the programmed cell death protein 1 (PD-1) inhibitor reported in the literature. CASE PRESENTATION A patient with liver cancer who received sintilimab injection, an anti-PD1 therapy, before LT was admitted in the transplantation centre. This patient underwent ABOi LT. The perioperative treatment strategy of this patient was reported. A desensitisation protocol was conducted urgently for the patient before operation, and the immunosuppression programme of LT was adjusted. After operation, isoagglutinin titer and liver function indicators were strictly monitored. The patient recovered well after operation, and no sign of rejection reaction was observed. CONCLUSION We reported a patient with hepatocellular carcinoma (HCC) who received PD-1 inhibitor treatment before operation and successfully underwent ABOi LT. The present case report provides novel insights into the perioperative management of utilizing PD-1 inhibitors prior to ABOi LT in patients diagnosed with hepatocellular carcinoma (HCC).
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Affiliation(s)
- Yipeng Pan
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China
| | - Jicheng Hu
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China
| | - Tao Li
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China
| | - Shanbin Zhang
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China
| | - Wanbang Zhou
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China
| | - Jiangbo Sun
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China
| | - Jianli Wang
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China; Organ Transplant Center, Tianjin First Central Hospital, Tianjin 300190, PR China.
| | - Wei Li
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China.
| | - Jian Xu
- Department of Transplantation, the Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan 570311, PR China.
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Han CZ, Wei Q, Yang MF, Zhuang L, Xu X. The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation. Hepatobiliary Pancreat Dis Int 2022; 21:538-542. [PMID: 35831217 DOI: 10.1016/j.hbpd.2022.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 05/17/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND The shortage of donor liver restricts liver transplantation (LT). Nowadays, donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver. Although it is now possible to perform ABO-incompatible (ABO-I) LT, antibody-mediated rejection (AMR) has been recognized as the primary cause of desperate outcomes after ABO-I LT. Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury. Therapeutic plasma exchange (TPE) can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity. DATA SOURCES We searched PubMed and CNKI databases using search terms "therapeutic plasma exchange", "ABO-incompatible liver transplantation", "ABO-I LT", "liver transplantation", "LT", "antibody-mediated rejection", and "AMR". Additional publications were identified by a manual search of references from key articles. The relevant publications published before September 30, 2020 were included in this review. RESULTS Different centers have made different attempts on whether to use TPE, when to use TPE and how often to use TPE. However, the control standard of lectin revision level is always controversial, the target titer varies significantly from center to center, and the standard target titer has not yet been established. TPE has several schemes to reduce antibody titers, but there is a lack of clinical trials that provide standardized procedures. CONCLUSIONS TPE is essential for ABO-I LT. Hence, further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.
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Affiliation(s)
- Cheng-Zuo Han
- Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China
| | - Qiang Wei
- Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China; National Center for Healthcare Quality Management in Liver Transplant, Hangzhou 310003, China
| | - Meng-Fan Yang
- Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China
| | - Li Zhuang
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China
| | - Xiao Xu
- Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China; National Center for Healthcare Quality Management in Liver Transplant, Hangzhou 310003, China.
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Markiewicz-Kijewska M, Kaliciński P, Torres Canizales J, Di Giorgio A, Baumann U, Jorns C, Baker A, Lopes MF, Frauca Remacha E, Lopez-Granados E, Jara Vega P, Basso MS, Kowalewski G, Kamińska D, Ferreira S, Liccardo D, Pietrobattista A, Spada M, on behalf of ERN TransplantChild Healthcare Working Group. ABO Incompatible Liver Transplantation in Children: A 20 Year Experience from Centres in the TransplantChild European Reference Network. CHILDREN-BASEL 2021; 8:children8090760. [PMID: 34572193 PMCID: PMC8468154 DOI: 10.3390/children8090760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022]
Abstract
An increasing number of AB0-incompatible (AB0i) liver transplantations (LT) are being undertaken internationally in recent years due to organ shortages and the need for urgent transplantation. The aim of our study was establish the value of ABOi LT from available retrospective results of AB0i pediatric liver transplantations performed in European reference centers now belonging to the TransplantChild, European Reference Network (ERN). Data from medical records were analyzed, including demographic data, diagnosis, urgency of transplantation, time on the waiting list, PELD/MELD score, desensitization procedures, immunosuppression, selected post-transplant complications, and patient and graft survival. A total of 142 patients (pts) with transplants between 1986 and 2018 in 8 European transplant centers were included in the study. The indications for liver transplantation were: cholestatic diseases in 62 pts, acute liver failure in 42 pts, and other conditions in the remaining 38 pts. Sixty-six patients received grafts from living donors, and seventy-six received grafts from deceased donors. Both patient and graft survival were significantly affected by deceased donor type, urgent transplantation, and the development of vascular complications. In the multivariate analysis, vascular complications had a negative impact on patient and graft survival, while a longer time from the first AB0i LT in the study showed better results, suggesting an international learning experience. In conclusion, we believe that AB0i LT in children is now a safe procedure that may be adopted more readily in children.
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Affiliation(s)
- Małgorzata Markiewicz-Kijewska
- Department of Pediatric Surgery and Organ Transplantation, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.M.-K.); (G.K.)
| | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.M.-K.); (G.K.)
- Correspondence: ; Tel.: +48-22-615-13-60
| | - Juan Torres Canizales
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Lymphocyte Pathophysiology in Immunodeficiencies Group, Immunology Unit, La Paz Institute of Biomedical Research (IdiPAZ), La Paz University Hospital, 28046 Madrid, Spain; (J.T.C.); (E.L.-G.)
| | - Angelo Di Giorgio
- Department of Pediatric Hepatology, Gastroenterology and Transplantation, ASST Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Hannover Medical School, 30625 Hannover, Germany;
| | - Carl Jorns
- Department of Transplantation Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Alastair Baker
- Pediatric Liver, Gastrointestinal and Nutrition Centre, King’s College London School of Medicine, King’s College Hospital, Denmark Hill, London SE5 9RS, UK;
| | - Maria Francelina Lopes
- Department of Pediatric Surgery, Centro de Investigação e Formação Clínica, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal;
| | - Esteban Frauca Remacha
- Servicio de Hepatología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain; (E.F.R.); (P.J.V.)
| | - Eduardo Lopez-Granados
- Center for Biomedical Network Research on Rare Diseases (CIBERER U767), Lymphocyte Pathophysiology in Immunodeficiencies Group, Immunology Unit, La Paz Institute of Biomedical Research (IdiPAZ), La Paz University Hospital, 28046 Madrid, Spain; (J.T.C.); (E.L.-G.)
| | - Paloma Jara Vega
- Servicio de Hepatología Pediátrica, Hospital Universitario La Paz, 28046 Madrid, Spain; (E.F.R.); (P.J.V.)
| | - Maria-Sole Basso
- Department of Hepatology, Gastroenterology and Nutrition, Ospedale Pediatrico Bambino Gesu, 00165 Roma, Italy; (M.-S.B.); (D.L.); (A.P.)
| | - Grzegorz Kowalewski
- Department of Pediatric Surgery and Organ Transplantation, Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.M.-K.); (G.K.)
| | - Diana Kamińska
- The Department of Gastroenterology, Hepatology, Nutrition Disorder and Pediatric, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Sandra Ferreira
- Hepatology and Pediatric Liver Transplantation Unit, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal;
| | - Daniela Liccardo
- Department of Hepatology, Gastroenterology and Nutrition, Ospedale Pediatrico Bambino Gesu, 00165 Roma, Italy; (M.-S.B.); (D.L.); (A.P.)
| | - Andrea Pietrobattista
- Department of Hepatology, Gastroenterology and Nutrition, Ospedale Pediatrico Bambino Gesu, 00165 Roma, Italy; (M.-S.B.); (D.L.); (A.P.)
| | - Marco Spada
- Department of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children’s Hospital IRCCS, 00165 Rome, Italy;
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Mysore KR, Himes RW, Rana A, Teruya J, Desai MS, Srivaths PR, Zaruca K, Calvert A, Guffey D, Minard CG, Morita E, Hensch L, Losos M, Kostousov V, Hui SKR, Orange JS, Goss JA, Nicholas SK. ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes. Pediatr Transplant 2018; 22:e13263. [PMID: 30070010 PMCID: PMC6197909 DOI: 10.1111/petr.13263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/18/2018] [Indexed: 12/16/2022]
Abstract
ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.
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Affiliation(s)
- Krupa R. Mysore
- Section of Pediatric Gastroenterology, Texas Children’s Hospital, Baylor College of Medicine
| | - Ryan W. Himes
- Section of Pediatric Gastroenterology, Texas Children’s Hospital, Baylor College of Medicine
| | - Abbas Rana
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Jun Teruya
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Moreshwar S. Desai
- Section of Pediatric Critical Care, Texas Children’s Hospital, Baylor College of Medicine
| | | | - Kimberly Zaruca
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | | | - Danielle Guffey
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine
| | - Charles G. Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine
| | - Eda Morita
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Lisa Hensch
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Michael Losos
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Vadim Kostousov
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Shiu-Ki Rocky Hui
- Department of Pathology, Transfusion Medicine, Baylor College of Medicine
| | - Jordan S. Orange
- Section of Pediatric Allergy & Immunology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - John A. Goss
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine
| | - Sarah K. Nicholas
- Section of Pediatric Allergy & Immunology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
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Feasibility of Monotherapy by Rituximab Without Additional Desensitization in ABO-incompatible Living-Donor Liver Transplantation. Transplantation 2018; 102:97-104. [PMID: 28938311 DOI: 10.1097/tp.0000000000001956] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Rituximab is a cornerstone in the regimens of desensitization for ABO-incompatible living-donor liver transplantation (ABO-i LDLT) that makes this modality an acceptable option for liver transplantation. Plasmapheresis (PP) to reduce anti-ABO antibody titer and local infusion (LI) therapy were practiced as the strategies for desensitization before the application of rituximab and were reported as additional treatments. The aim of this study was to clarify the feasibility of monotherapy by rituximab without any additional desensitization treatments in ABO-i LT. METHODS Forty patients receiving ABO-i LDLT with rituximab were enrolled in this retrospective study. The patients were divided into 2 groups: the rituximab with pretransplant PP and posttransplant LI (RPL) group (n = 20) and the rituximab monotherapy (RM) without any additional treatment group (n = 20). The groups were then compared in terms of the rates of patient survival, antibody-mediated rejection (AMR), and infection. RESULTS The 1-, 3-, and 5-year patient survival rates were 85%, 85%, and 85% in the RPL group and 89%, 80%, and 80% in the RM group, respectively. There was no significant difference in patient survival between the 2 groups. There were no episodes of AMR in either group. The RM group had a lower rate of fungal and viral infections than the RPL group. CONCLUSIONS Pretransplant rituximab without additional treatments yielded satisfactory outcomes comparable to that with additional treatments, such as PP and LI.
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Goss MB, Rana A. ABO-incompatible liver transplantation: Is it a viable option with modern innovation? Clin Liver Dis (Hoboken) 2017; 10:124-129. [PMID: 30992771 PMCID: PMC6467122 DOI: 10.1002/cld.673] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/11/2017] [Accepted: 10/11/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Matthew B. Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTX77030
| | - Abbas Rana
- Division of Abdominal Transplantation, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonTX77030
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Ye LP, Zhang C, Zhu QX. The Effect of Intravenous Immunoglobulin Combined with Corticosteroid on the Progression of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis. PLoS One 2016; 11:e0167120. [PMID: 27902746 PMCID: PMC5130247 DOI: 10.1371/journal.pone.0167120] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 11/09/2016] [Indexed: 01/04/2023] Open
Abstract
Background Intravenous immunoglobulin (IVIG) treatment is commonly used to treat Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) with controversial therapeutic effect. Methods We conducted a comprehensive meta-analysis through combining the published eligible studies to evaluate the effectiveness of IVIG on SJS and TEN treatment. Results A total of 26 studies were selected from public available databases. The combination of IVIG and corticosteroid markedly reduced the recovery time (by 1.63 days, 95% CI: 0.83–2.43, P < 0.001), compared with solo corticosteroid group. The favorable effects were greater in Asian (2.19, 95% CI: 1.41–2.97, P < 0.001), TEN (2.56, 95% CI: 0.35–4.77, P = 0.023) and high-dose IVIG treated individuals (1.78, 95% CI: 0.42–3.14, P = 0.010). The hospitalization length reduced by 3.19 days (95% CI: 0.08–6.30, P = 0.045), though the outcome was proven to be unstable. We found heterogeneities, which sources were probably regional factors. Besides, IVIG was inclined to decrease SJS/TEN mortality (SMR: 0.84, 95% CI: 0.66–1.08, P = 0.178). This impact was possibly more profound when patients were treated with high dose IVIG (SMR: 0.74, 95% CI: 0.50–1.08, P = 0.116), or when patients were diagnosed as TEN (SMR: 0.68, 95% CI: 0.45–1.01, P = 0.058). Conclusions Our current meta-analysis suggests that IVIG combined with corticosteroid could reduce recovery time for SJS and TEN. This effect is greater among Asian patients. Whereas, its impact on reducing mortality is not significant.
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Affiliation(s)
- Liang-ping Ye
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, Anhui, China
- Physical Examination Centre, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Cheng Zhang
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qi-xing Zhu
- Institute of Dermatology and Department of Dermatology at No.1 Hospital, Anhui Medical University, Hefei, Anhui, China
- Department of Occupational and Environmental Health, School of Public Health, Anhui Medical University, Hefei, Anhui, China
- * E-mail: . (QXZ)
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Rummler S, Bauschke A, Bärthel E, Jütte H, Maier K, Ziehm P, Malessa C, Settmacher U. Current techniques for AB0-incompatible living donor liver transplantation. World J Transplant 2016; 6:548-555. [PMID: 27683633 PMCID: PMC5036124 DOI: 10.5500/wjt.v6.i3.548] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/24/2016] [Accepted: 07/22/2016] [Indexed: 02/05/2023] Open
Abstract
For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible (AB0i) grafts. Improvements in AB0i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0i living donor liver transplantation (LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients’ graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0i LDLT is a feasible option today and almost free of severe complications.
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Bang JB, Kim BW, Kim YB, Wang HJ, Lee HY, Sim J, Kim T, Lee KL, Hu XG, Mao W. Risk factor for ischemic-type biliary lesion after ABO-incompatible living donor liver transplantation. World J Gastroenterol 2016; 22:6925-6935. [PMID: 27570428 PMCID: PMC4974590 DOI: 10.3748/wjg.v22.i30.6925] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/07/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023] Open
Abstract
AIM: To evaluate the risk factors for ischemic-type biliary lesion (ITBL) after ABO-incompatible (ABO-I) adult living donor liver transplantation (ALDLT).
METHODS: Among 141 ALDLTs performed in our hospital between 2008 and 2014, 27 (19%) were ABO-I ALDLT and 114 were ABO-identical/compatible ALDLT. In this study, we extensively analyzed the clinico-pathological data of the 27 ABO-I recipients to determine the risk factors for ITBL after ABO-I ALDLT. All ABO-I ALDLT recipients underwent an identical B-cell depletion protocol with preoperative rituximab, plasma exchange (PE), and operative splenectomy. The median follow-up period after transplantation was 26 mo. The clinical outcomes of the 27 ABO-I ALDLT recipients were compared with those of 114 ABO-identical/compatible ALDLT recipients.
RESULTS: ITBL occurred in four recipients (14.8%) between 45 and 112 d after ABO-I ALDLT. The overall survival rates were not different between ABO-I ALDLT and ABO-identical/compatible ALDLT (P = 0.303). Among the ABO-I ALDLT recipients, there was no difference between patients with ITBL and those without ITBL in terms of B-cell and T-cell count, serum isoagglutinin titers, number of PEs, operative time and transfusion, use of graft infusion therapy, or number of remnant B-cell follicles and plasma cells in the spleen. However, the perioperative NK cell counts in the blood of patients with ITBL were significantly higher than those in the patients without ITBL (P < 0.05). Preoperative NK cell count > 150/μL and postoperative NK cell count > 120/μL were associated with greater relative risks (RR) for development of ITBL (RR = 20 and 14.3, respectively, P < 0.05).
CONCLUSION: High NK cell counts in a transplant recipient’s blood are associated with ITBL after ABO-I ALDLT. Further research is needed to elucidate the molecular mechanism of NK cell involvement in the development of ITBL.
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Results of ABO-incompatible liver transplantation using a simplified protocol at a single institution. Transplant Proc 2015; 47:723-6. [PMID: 25891718 DOI: 10.1016/j.transproceed.2015.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 01/25/2015] [Accepted: 02/09/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND Because of the development of various desensitization strategies, ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has become a feasible option for patients with end-stage liver disease. However, there has been no united desensitization protocol for ABOi LDLT. We analyzed the outcomes after establishment of simplified protocol without splenectomy, intravenous immunoglobulin, and local infusion therapy. METHODS We analyzed 19 ABOi LDLT cases that had been performed between January 2012 and December 2013, without splenectomy and local infusion. We used a single dose of rituximab (375 mg/m(2)) 10 days before transplantation and several series of plasma exchange according to the recipients' iso-agglutinin titer-to-target titer ratio of 1:32. RESULTS Nineteen recipients received ABOi LTs from living donors. The mean initial immunoglobulin (Ig) M and IgG anti-ABO titers were 76.63 ± 78.81 (range, 8∼256) and 162.53 ± 464.1 (0∼2048). We performed preoperative plasma exchange to 16 recipients (mean number of sessions, 3.58; range, 1-10). After surgery, 9 patients received plasma exchange (mean, 1.84; range 1∼14). One death occurred as the result of pneumonia (5.3%). There were 4 cases of acute rejections (21.1%), and all of them were treated successfully with steroid pulse or thymoglobulin. Antibody-mediated rejection and graft failure did not occur. Six cases of postoperative complications (31.6%) occurred, including 3 cases of infections. There were 2 cases of biliary anastomotic stricture (10.5%) and 1 case of portal vein stenosis (5.3%). CONCLUSIONS ABOi LDLT with the use of simplified protocol can be safely performed without increased risk of antibody-mediated rejection and other complications.
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Kornberg A. Intravenous immunoglobulins in liver transplant patients: Perspectives of clinical immune modulation. World J Hepatol 2015; 7:1494-1508. [PMID: 26085909 PMCID: PMC4462688 DOI: 10.4254/wjh.v7.i11.1494] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 04/19/2015] [Accepted: 05/08/2015] [Indexed: 02/06/2023] Open
Abstract
Shortage of appropriate donor grafts is the foremost current problem in organ transplantation. As a logical consequence, waiting times have extended and pretransplant mortality rates were significantly increasing. The implementation of a priority-based liver allocation system using the model of end-stage liver disease (MELD) score helped to reduce waiting list mortality in liver transplantation (LT). However, due to an escalating organ scarcity, pre-LT MELD scores have significantly increased and liver recipients became more complex in recent years. This has finally led to posttransplant decreasing survival rates, attributed mainly to elevated rates of infectious and immunologic complications. To meet this challenging development, an increasing number of extended criteria donor grafts are currently accepted, which may, however, aggravate the patients’ infectious and immunologic risk profiles. The administration of intravenous immunoglobulins (IVIg) is an established treatment in patients with immune deficiencies and other antibody-mediated diseases. In addition, IVIg was shown to be useful in treatment of several disorders caused by deterioration of the cellular immune system. It proved to be effective in preventing hyperacute rejection in highly sensitized kidney and heart transplants. In the liver transplant setting, the administration of specific Ig against hepatitis B virus is current standard in post-LT antiviral prophylaxis. The mechanisms of action of IVIg are complex and not fully understood. However, there is increasing experimental and clinical evidence that IVIg has an immuno-balancing impact by a combination of immuno-supporting and immuno-suppressive properties. It may be suggested that, especially in the context of a worsening organ shortage with all resulting clinical implications, liver transplant patients should benefit from immuno-regulatory capabilities of IVIg. In this review, perspectives of immune modulation by IVIg and impact on outcome in liver transplant patients are described.
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Jawan B, Wang CH, Chen CL, Huang CJ, Cheng KW, Wu SC, Shih TH, Yang SC. Review of anesthesia in liver transplantation. ACTA ACUST UNITED AC 2014; 52:185-96. [PMID: 25477262 DOI: 10.1016/j.aat.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/26/2014] [Indexed: 01/10/2023]
Abstract
Liver transplantation (LT) is a well-accepted treatment modality of many end-stage liver diseases. The main issue in LT is the shortage of deceased donors to accommodate the needs of patients waiting for such transplants. Live donors have tremendously increased the pool of available liver grafts, especially in countries where deceased donors are not common. The main ethical concern of this procedure is the safety of healthy donors, who undergo a major abdominal surgery not for their own health, but to help cure others. The first part of the review concentrates on live donor selection, preanesthetic evaluation, and intraoperative anesthetic care for living liver donors. The second part reviews patient evaluation, intraoperative anesthesia monitoring, and fluid management of the recipient. This review provides up-to-date information to help improve the quality of anesthesia, and contribute to the success of LT and increase the long-term survival of the recipients.
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Affiliation(s)
- Bruno Jawan
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Chih-Hsien Wang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chao-Long Chen
- Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chia-Jung Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kwok-Wai Cheng
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Hsiao Shih
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Chun Yang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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