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ABO‐incompatible deceased donor pediatric liver transplantation: Novel titer‐based management protocol and outcomes
Author(s) -
Mysore Krupa R.,
Himes Ryan W.,
Rana Abbas,
Teruya Jun,
Desai Moreshwar S.,
Srivaths Poyyapakkam R.,
Zaruca Kimberly,
Calvert Andrea,
Guffey Danielle,
Minard Charles G.,
Morita Eda,
Hensch Lisa,
Losos Michael,
Kostousov Vadim,
Hui ShiuKi Rocky,
Orange Jordan S.,
Goss John A.,
Nicholas Sarah K.
Publication year - 2018
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13263
Subject(s) - medicine , abo blood group system , rituximab , plasmapheresis , transplantation , tacrolimus , titer , surgery , immunology , antibody , lymphoma
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.