Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases
ABO-incompatible (ABOi) living donor liver transplantation (LDLT) carries a substantial risk of antibody-mediated rejection (AMR) in both the short and long term. However, when no ABO-compatible donor is available, ABOi LDLT can be a viable option for patients with liver failure requiring emergency...
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| Language: | English |
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The Korean Society for Transplantation
2025-06-01
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| Series: | Clinical Transplantation and Research |
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| Online Access: | https://www.ctrjournal.org/journal/view.html?doi=10.4285/ctr.24.0061 |
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| author | Nalini Kanta Ghosh Kausar Makki Yogesh Yadav Tathagata Karan Piyush Srivastava Anil Agarwal Vivek Vij |
| author_facet | Nalini Kanta Ghosh Kausar Makki Yogesh Yadav Tathagata Karan Piyush Srivastava Anil Agarwal Vivek Vij |
| author_sort | Nalini Kanta Ghosh |
| collection | DOAJ |
| description | ABO-incompatible (ABOi) living donor liver transplantation (LDLT) carries a substantial risk of antibody-mediated rejection (AMR) in both the short and long term. However, when no ABO-compatible donor is available, ABOi LDLT can be a viable option for patients with liver failure requiring emergency transplantation. To prevent AMR, various strategies have been implemented. However, typically, a pretransplant preparation period of at least 2 to 3 weeks is required to reduce the CD19+ or CD20+ cell count and antibody levels to an acceptable threshold (1:64). In emergency ABOi cases, due to time constraints, the desensitization protocol must be modified in accordance with the patient’s needs. We present a series of three cases involving emergency ABOi LDLT: one of primary graft nonfunction and two of acute-on-chronic liver failure. The goal was to achieve both short- and long-term rejection-free outcomes. Each case required different protocols based on the patient’s antibody titer, clinical condition, and intraoperative findings, and postoperative immunosuppression regimens were also individualized according to each patient’s clinical condition. This case series demonstrates the safety and feasibility of emergency ABOi LDLT with modifications to the desensitization protocol. However, further research into emergency ABOi transplantation is necessary to establish recommendations for managing such patients. |
| format | Article |
| id | doaj-art-059c7c5a54ce48788c63b6b4bf7c8ef2 |
| institution | Kabale University |
| issn | 3022-6783 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | The Korean Society for Transplantation |
| record_format | Article |
| series | Clinical Transplantation and Research |
| spelling | doaj-art-059c7c5a54ce48788c63b6b4bf7c8ef22025-08-20T03:24:11ZengThe Korean Society for TransplantationClinical Transplantation and Research3022-67832025-06-0139216116810.4285/ctr.24.0061ctr.24.0061Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three casesNalini Kanta Ghosh0Kausar Makki1Yogesh Yadav2Tathagata Karan3Piyush Srivastava4Anil Agarwal5Vivek Vij6Department of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, IndiaDepartment of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, IndiaDepartment of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, IndiaDepartment of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, IndiaDepartment of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital, Noida, IndiaDepartment of Liver Transplant Anaesthesia and Critical Care, Fortis Hospital, Noida, IndiaDepartment of Liver Transplant and HPB Surgery, Fortis Hospital, Noida, IndiaABO-incompatible (ABOi) living donor liver transplantation (LDLT) carries a substantial risk of antibody-mediated rejection (AMR) in both the short and long term. However, when no ABO-compatible donor is available, ABOi LDLT can be a viable option for patients with liver failure requiring emergency transplantation. To prevent AMR, various strategies have been implemented. However, typically, a pretransplant preparation period of at least 2 to 3 weeks is required to reduce the CD19+ or CD20+ cell count and antibody levels to an acceptable threshold (1:64). In emergency ABOi cases, due to time constraints, the desensitization protocol must be modified in accordance with the patient’s needs. We present a series of three cases involving emergency ABOi LDLT: one of primary graft nonfunction and two of acute-on-chronic liver failure. The goal was to achieve both short- and long-term rejection-free outcomes. Each case required different protocols based on the patient’s antibody titer, clinical condition, and intraoperative findings, and postoperative immunosuppression regimens were also individualized according to each patient’s clinical condition. This case series demonstrates the safety and feasibility of emergency ABOi LDLT with modifications to the desensitization protocol. However, further research into emergency ABOi transplantation is necessary to establish recommendations for managing such patients.https://www.ctrjournal.org/journal/view.html?doi=10.4285/ctr.24.0061primary graft nonfunctionacute-on-chronic liver failureblood group incompatibilitydesensitizationliver transplantation |
| spellingShingle | Nalini Kanta Ghosh Kausar Makki Yogesh Yadav Tathagata Karan Piyush Srivastava Anil Agarwal Vivek Vij Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases Clinical Transplantation and Research primary graft nonfunction acute-on-chronic liver failure blood group incompatibility desensitization liver transplantation |
| title | Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases |
| title_full | Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases |
| title_fullStr | Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases |
| title_full_unstemmed | Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases |
| title_short | Tailored strategies for emergency ABO-incompatible living donor liver transplantation: a series of three cases |
| title_sort | tailored strategies for emergency abo incompatible living donor liver transplantation a series of three cases |
| topic | primary graft nonfunction acute-on-chronic liver failure blood group incompatibility desensitization liver transplantation |
| url | https://www.ctrjournal.org/journal/view.html?doi=10.4285/ctr.24.0061 |
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