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Pediatric ABO-incompatible Living Related Donor Liver Transplantation: Experience from Indian Subcontinent

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Abstract

We present our experience with pediatric ABO-incompatible liver transplantation in India. Data of patients <18 years of age undergoing ABO-incompatible liver transplantation our hospital between January, 2011 and November, 2018 were analyzed. Plasmapheresis was done pre-transplant till antibody titer was <16 units. Rituximab/Intravenous immunoglobulin was used for immunosuppression, in addition to standard drugs (mycophenolate mofetil, steroids, and tacrolimus). Out of 203 patients that underwent liver transplant during this period, 8 underwent ABO-incompatible liver transplantation; 4 (3 boys) had blood group O+ve. Median (range) age was 28 (7–91) mo, PELD score was 24.5 (14–42), and pre-transplant antibody titer range was 1:32–1024. Number of plasmapheresis sessions required ranged from 1–6. Post-operatively two patients had rise in antibody titer >64 requiring plasmapheresis. All 8 patients survived without rejection/biliary issues. Mean (range) of post-transplant hospital stay was 19.1 (13–22) d and follow-up period was 38.1 (7.1–84.4) mo. Pediatric ABO-incompatible liver transplantation can be successfully performed using plasmapheresis with optimal immune-suppression and vigilant post-op monitoring.

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Authors and Affiliations

  1. Department of Pediatric Gastroenterology and Hepatology, Medanta-The Medicity, Gurgaon, Haryana, India

    Neelam Mohan

  2. Department of Pediatric Critical Care, Medanta-The Medicity, Gurgaon, Haryana, India

    Veena Raghunathan & Maninder Singh Dhaliwal

  3. Department of Surgery, Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana, India

    Prashant Bhangui & Arvinder S. Soin

  4. Department of Laboratory Medicine, Pathology and Blood Bank, Medanta-The Medicity, Gurgaon, Haryana, India

    Aseem Tiwari

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  1. Neelam Mohan
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  2. Veena Raghunathan
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  3. Maninder Singh Dhaliwal
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  4. Prashant Bhangui
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  5. Aseem Tiwari
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  6. Arvinder S. Soin
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Correspondence to Neelam Mohan.

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Contributors

NM,VR: wrote the manuscript; MD: contributed to design, data compilation and analysis; MD, AT: data compilation and manuscript writing; PB,AS: contributed to the surgical aspects of the manuscript. VR,PB,MD: involved in coordination of the study and revision of the manuscript; NM, AS: final editing of the manuscript. All authors approved the final manuscript.

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Mohan, N., Raghunathan, V., Dhaliwal, M.S. et al. Pediatric ABO-incompatible Living Related Donor Liver Transplantation: Experience from Indian Subcontinent. Indian Pediatr 58, 281–282 (2021). https://doi.org/10.1007/s13312-021-2172-z

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  • DOI: https://doi.org/10.1007/s13312-021-2172-z

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