Case Report

Journal of Gastroenterology

, Volume 47, Issue 4, pp 486-488

Open Access This content is freely available online to anyone, anywhere at any time.

Living donor liver transplantation using sensitized lymphocytotoxic crossmatch positive graft

  • Taku AokiAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo
  • , Yasuhiko SugawaraAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo Email author 
  • , Michiro TakahashiAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo
  • , Yoshikuni KawaguchiAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo
  • , Junichi KanekoAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo
  • , Noriyo YamashikiAffiliated withOrgan Transplantation Service, University of Tokyo
  • , Sumihito TamuraAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo
  • , Kiyoshi HasegawaAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo
  • , Kouki TakahashiAffiliated withDepartment of Transfusion Medicine, Graduate School of Medicine, University of Tokyo
    • , Norihiro KokudoAffiliated withHepato-Biliary-Pancreatic Surgery Division, Department of Surgery, University of TokyoArtificial Organ and Transplantation Division, Department of Surgery, University of Tokyo

Abstract

We describe a successful living donor liver transplantation (LDLT) using a lymphocytotoxic crossmatch highly positive graft. A 41-year-old woman with alcoholic liver cirrhosis was referred as a potential candidate for LDLT, and her husband was willing to donate his partial liver. As the T-lymphocytotoxic crossmatch titer was over 10,000×, the patient was first infused with rituximab for preoperative desensitization, and then five rounds of plasmapheresis were performed. After the third plasmapheresis, the lymphocytotoxic crossmatch test was negative. A left liver graft including the caudate lobe was implanted, and anti-CD25 antibody (basiliximab) was administered on postoperative days 1 and 4. The postoperative course was uneventful except for an episode of mild acute cellular rejection on postoperative day 27. Although the impact of a lymphocytotoxic crossmatch-positive liver graft on acute cellular rejection and graft survival in LDLT remains controversial, perioperative desensitization may provide benefits when using a highly sensitized liver graft.

Keywords

Anti-CD25 antibody Lymphocytotoxic crossmatch Living donor