Makroo R N, Agrawal Soma, Chowdhry Mohit, Kakkar Brinda, Thakur Uday K
Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
Department of Transfusion Medicine and Immunohematology, Indraprastha Apollo Hospitals, New Delhi, India.
Transfus Apher Sci. 2016 Dec;55(3):329-332. doi: 10.1016/j.transci.2016.08.007. Epub 2016 Sep 28.
Liver transplantation is one of the solid organs most commonly being transplanted across the world. The indications, affordability and accessibility have grown manifold. To increase the donor pool, inclusion of ABO incompatible liver donors is being considered. To enhance the graft functioning and survival, immunoadsorption apheresis to reduce the ABO hemagglutination titres are on the rise.
We report three cases ABO incompatible liver transplantation with immunoadsorption protocol. The patients were in poor general condition with Child-Turcotte-Pugh (CTP) class 'C' and there were no suitable ABO compatible grafts at the time. For all three cases, immunosuppressive protocol consisted of induction with Rituximab, followed by tacrolimus, mycophenolate mofetil and corticosteroids. The third patient received basiliximab for induction, in addition to the above protocol. First 2 patients received 1 immunoadsorption (IA) session with Glycosorb ABO® system (Glycorex AB, Sweden), pre-operatively. The third patient received 2 IA sessions pre-operatively. Baseline IgM plus IgG titres were 1024; 64 and 1024 for anti-B, anti-A and anti-B for patient 1, 2 and 3 respectively. Target pre-operative antibody titre was ≤16. Average post-operative length of stay was 17.3 days. There were no acute rejection. None of them, required any post-operative plasma exchange.
Immunoadsorption is effective in reducing hemagglutination titres in recipients of ABO incompatible donor liver.
肝移植是全球最常进行的实体器官移植之一。其适应证、可承受性和可及性都有了显著增长。为了增加供体库，正在考虑纳入ABO血型不相容的肝脏供体。为了提高移植物的功能和存活率，用于降低ABO血凝效价的免疫吸附治疗正在增加。
我们报告3例采用免疫吸附方案的ABO血型不相容肝移植病例。这些患者一般状况较差，Child-Turcotte-Pugh（CTP）分级为“C”级，当时没有合适的ABO血型相容的移植物。对于所有3例患者，免疫抑制方案包括使用利妥昔单抗进行诱导，随后使用他克莫司、霉酚酸酯和皮质类固醇。除上述方案外，第3例患者诱导时还使用了巴利昔单抗。前2例患者在术前接受了1次使用Glycosorb ABO®系统（瑞典Glycorex AB公司）的免疫吸附（IA）治疗。第3例患者在术前接受了2次IA治疗。患者1、2和3的抗B、抗A和抗B的基线IgM加IgG效价分别为1024、64和1024。术前目标抗体效价≤16。术后平均住院时间为17.3天。没有发生急性排斥反应。他们中没有人需要术后进行血浆置换。
免疫吸附在降低ABO血型不相容供肝受者的血凝效价方面是有效的。
