Skip to main content

Advertisement

SpringerLink
Log in

Long-term outcomes following ABO-incompatible living donor liver transplantation for acute liver failure: a single-center experience of over 20 years

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Acute liver failure is a life-threatening condition for which ABO-incompatible living donor liver transplantation (ABOi-LDLT) is sometimes the only life-saving treatment option. We reviewed a single-center experience of adult ABOi-LDLT treatment for acute liver failure (ALF).

Methods

Preoperative treatment, immune indices (B cell marker, anti-donor blood-type antibody), and postoperative outcomes were compared between ALF and non-ALF groups.

Results

There were 5 and 33 patients in the ALF and non-ALF groups, respectively. The ALF group received higher doses of steroids, underwent more rounds of plasma exchange (PE), and underwent transplantation for ALF with a shorter interval following preoperative rituximab (RTx) administration (median: 2 vs 13 days; P < 0.05) than the non-ALF group. Preoperatively, CD19-positive lymphocytes in the peripheral blood were sufficiently depleted in all of the non-ALF group patients, whereas they were poorly depleted in the ALF group. Postoperatively, neither group suffered anti-donor blood-type antibody titer rebound or antibody-mediated rejection. The ALF group had a comparable 5-year survival rate to the non-ALF group (80.0% vs 77.9%).

Conclusions

Despite the delayed preoperative administration of RTx, the ALF group showed an uneventful immunological response and acceptable long-term survival rate. Thus, ABOi-LDLT seems a viable treatment option for ALF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

References

  1. Tanabe M, Shimazu M, Wakabayashi G, Hoshino K, Kawachi S, Kadomura T, et al. Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation. Transplantation. 2002;73(12):1959–61.

    Article  PubMed  Google Scholar 

  2. Kawagishi N, Satoh K, Enomoto Y, Akamatsu Y, Sekiguchi S, Fukumori T, et al. New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (rituximab) and plasma exchange. Transplant Proc. 2005;37(2):1205–6.

    Article  CAS  PubMed  Google Scholar 

  3. Usui M, Isaji S, Mizuno S, Sakurai H, Uemoto S. Experiences and problems pre-operative anti-CD20 monoclonal antibody infusion therapy with splenectomy and plasma exchange for ABO-incompatible living-donor liver transplantation. Clin Transplant. 2007;21(1):24–31.

    Article  PubMed  Google Scholar 

  4. Egawa H, Teramukai S, Haga H, Tanabe M, Fukushima M, Shimazu M. Present status of ABO-incompatible living donor liver transplantation in Japan. Hepatology. 2008;47(1):143–52.

    Article  PubMed  Google Scholar 

  5. Uchiyama H, Mano Y, Taketomi A, Soejima Y, Yoshizumi T, Ikegami T, et al. Kinetics of anti-blood type isoagglutinin titers and B lymphocytes in ABO-incompatible living donor liver transplantation with rituximab and plasma exchange. Transplantation. 2011;92(10):1134–9.

    Article  CAS  PubMed  Google Scholar 

  6. Tanabe M, Kawachi S, Obara H, Shinoda M, Hibi T, Kitagawa Y, et al. Current progress in ABO-incompatible liver transplantation. Eur J Clin Invest. 2010;40(10):943–9.

    Article  PubMed  Google Scholar 

  7. Umeshita K, Eguchi S, Egawa H, Haga H, Kasahara M, Kokudo N, et al. Liver transplantation in Japan: Registry by the Japanese Liver Transplantation Society. Hepatol Res. 2019;49(9):964–80.

    Article  PubMed  Google Scholar 

  8. Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM. End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates. Hepatology. 2012;55(1):192–8.

    Article  PubMed  Google Scholar 

  9. Kishida N, Shinoda M, Itano O, Obara H, Kitago M, Hibi T, et al. Increased incidence of thrombotic microangiopathy after ABO-incompatible living donor liver transplantation. Ann Transplant. 2016;21:755–64.

    Article  CAS  PubMed  Google Scholar 

  10. Wakabayashi T, Shinoda M, Obara H, Kitago M, Yagi H, Abe Y, et al. Decreased incidence of acute cellular rejection in low-muscle-mass recipients after living-donor liver transplantation. Transplant Proc. 2018;50(10):3626–34.

    Article  CAS  PubMed  Google Scholar 

  11. Abe K, Shinoda M, Uno S, Obara H, Kitago M, Abe Y, et al. Invasive pulmonary aspergillosis after liver transplantation: lessons from successfully treated cases and review of the literature. Surg Today. 2021;51(8):1361–70.

    Article  PubMed  Google Scholar 

  12. Farges O, Kalil AN, Samuel D, Saliba F, Arulnaden JL, Debat P, et al. The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients. Transplantation. 1995;59(8):1124–33.

    Article  CAS  PubMed  Google Scholar 

  13. Ikegami T, Taketomi A, Soejima Y, Yoshizumi T, Uchiyama H, Harada N, et al. Rituximab, IVIG, and plasma exchange without graft local infusion treatment: a new protocol in ABO incompatible living donor liver transplantation. Transplantation. 2009;88(3):303–7.

    Article  CAS  PubMed  Google Scholar 

  14. Horikoshi Y, Itoh H, Kikuchi S, Uchida T, Suzuki K, Sugihara K, et al. Successful living donor liver transplantation for fulminant hepatic failure that manifested immediately after cesarean delivery. Asaio J. 2012;58(2):174–6.

    Article  PubMed  Google Scholar 

  15. Yasuda M, Ikegami T, Imai D, Wang H, Bekki Y, Itoh S, et al. The changes in treatment strategies in ABOi living donor liver transplantation for acute liver failure. J Med Invest. 2015;62(3–4):184–7.

    Article  PubMed  Google Scholar 

  16. Lee B, Cho JY, Han HS, Yoon YS, Lee HW, Lee JS, et al. Long-term outcomes of emergency ABO-incompatible living donor liver transplantation using a modified desensitization protocol for highly sensitized patients with acute liver failure: a case report. Ann Hepatobiliary Pancreat Surg. 2021;25(4):571–4.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Egawa H, Teramukai S, Haga H, Tanabe M, Mori A, Ikegami T, et al. Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: a Japanese multicenter study. Am J Transplant. 2014;14(1):102–14.

    Article  CAS  PubMed  Google Scholar 

  18. Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier. Transplantation. 1994;58(5):543–7.

    Article  CAS  PubMed  Google Scholar 

  19. Bernal W, McPhail MJ. Acute liver failure. J Hepatol. 2021;74(6):1489–90.

    Article  PubMed  Google Scholar 

  20. Mizota T, Hishiki T, Shinoda M, Naito Y, Hirukawa K, Masugi Y, et al. The hypotaurine-taurine pathway as an antioxidative mechanism in patients with acute liver failure. J Clin Biochem Nutr. 2022;70(1):54–63.

    Article  CAS  PubMed  Google Scholar 

  21. Lill-Elghanian D, Schwartz K, King L, Fraker P. Glucocorticoid-induced apoptosis in early B cells from human bone marrow. Exp Biol Med (Maywood). 2002;227(9):763–70.

    Article  CAS  PubMed  Google Scholar 

  22. Gruver-Yates AL, Quinn MA, Cidlowski JA. Analysis of glucocorticoid receptors and their apoptotic response to dexamethasone in male murine B cells during development. Endocrinology. 2014;155(2):463–74.

    Article  PubMed  Google Scholar 

  23. 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(6):538–42.

    Article  PubMed  Google Scholar 

  24. Lee WC, Cheng CH, Lee CF, Hung HC, Lee JC, Wu TH, et al. Quick preparation of ABO-incompatible living donor liver transplantation for acute liver failure. Clin Transplant. 2022;36(3): e14555.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Ms. Chie Takaoka, Transplant Coordinator at Keio University Hospital, for data collection of referred patients.

Funding

No external funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Kazuya Hirukawa, Masahiro Shinoda, Yasushi Hasegawa, Hideaki Obara, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yohei Yamada & Yuko Kitagawa

  2. Digestive Diseases Center, Mita Hospital, International University of Health and Welfare, 1-4-3 Mita, Minato-Ku, Tokyo, 108-0073, Japan

    Masahiro Shinoda

  3. Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan

    Minoru Tanabe

Authors
  1. Kazuya Hirukawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masahiro Shinoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasushi Hasegawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideaki Obara
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Minoru Kitago
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Yagi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuta Abe
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yohei Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Minoru Tanabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yuko Kitagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

KH contributed to research design, data analysis, and writing of the manuscript. MS participated in research design, data analysis, and writing of the manuscript. OI, HO, MK, KT, HY, and YA were involved in the research. YK contributed to the research design.

Corresponding author

Correspondence to Masahiro Shinoda.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare in relation to this article.

Ethics statement

The protocol for this research project has been approved by the Institutional Review Board of our institute and it conforms to the provisions of the Declaration of Helsinki (approval numbers: 20080136 and 20120443). Informed patient consent was waived due to the retrospective nature of this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hirukawa, K., Shinoda, M., Hasegawa, Y. et al. Long-term outcomes following ABO-incompatible living donor liver transplantation for acute liver failure: a single-center experience of over 20 years. Surg Today 53, 1160–1172 (2023). https://doi.org/10.1007/s00595-023-02678-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-023-02678-w

Keywords

Search

Navigation