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Surgery Today
Published in: Surgery Today 10/2023

05-06-2023 | Acute Liver Failure | Original Article

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

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

Published in: Surgery Today | Issue 10/2023

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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.
Appendix
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Metadata
Title
Long-term outcomes following ABO-incompatible living donor liver transplantation for acute liver failure: a single-center experience of over 20 years
Authors
Kazuya Hirukawa
Masahiro Shinoda
Yasushi Hasegawa
Hideaki Obara
Minoru Kitago
Hiroshi Yagi
Yuta Abe
Yohei Yamada
Minoru Tanabe
Yuko Kitagawa
Publication date
05-06-2023
Publisher
Springer Nature Singapore
Published in
Surgery Today / Issue 10/2023
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-023-02678-w

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