ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes

Krupa R. Mysore, Ryan W. Himes, Abbas Rana, Jun Teruya, Moreshwar S. Desai, Poyyapakkam R. Srivaths, Kimberly Zaruca, Andrea Calvert, Danielle Guffey, Charles G. Minard, Eda Morita, Lisa Hensch, Michael Losos, Vadim Kostousov, Shiu Ki Rocky Hui, Jordan S. Orange, John A. Goss, Sarah K. Nicholas

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

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.

Original languageEnglish (US)
Article numbere13263
JournalPediatric Transplantation
Volume22
Issue number7
DOIs
StatePublished - Nov 2018

Keywords

  • ABO incompatible
  • deceased donor
  • immunosuppression
  • isohemagglutinin
  • liver transplant
  • pediatric
  • plasmapheresis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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