Bajpai Meenu, Kakkar Brinda, Gupta Shruti, Rastogi Archana, Pamecha Viniyendra
Department of Transfusion Medicine, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India.
Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, 110 070, India.
Transfus Apher Sci. 2019 Aug;58(4):442-446. doi: 10.1016/j.transci.2019.04.028. Epub 2019 Jul 10.
The reduction of antibody titres (AT's) to a safe level is essential pre-requisite for patients awaiting ABO-incompatible liver transplantation (ABOi LT). We report our experience of performing cascade plasmapheresis (CP) on 2 different apheresis platforms (COBE Spectra and Spectra Optia) as a desensitization strategy for patients undergoing ABOi LT in our centre.
This retrospective observational study was conducted on patients who underwent CP included in the desensitization protocol for ABOi LDLT. CP/conventional TPE was performed (daily/alternate day with daily estimation of AT) until a target titre of ≤ 8 was achieved.
During the study period, 4 patients (mean age 46.7 years; 100% males) underwent desensitization for ABOi LDLT with baseline AT (combined IgM and IgG) ranging from 64 to 512. A total of 15 CP sessions (range 2 - 6) were performed with a median of 3.5 sessions/patient. Desensitization rate was 100%. Only 1 patient underwent conventional TPE in the post-transplant due to rise in AT level to 64 (post-operative day 8). Average post-operative length of stay was 49 days (range 30 - 105). None of the patients experienced any episode of rejection (repeat liver biopsy). On follow up (1 year), 2 patients were alive and doing well, while other 2 patients succumbed during their hospital stay due to sepsis.
In our limited experience, the use of CP was safe and effective desensitization strategy for patients undergoing ABOi LDLT.
将抗体滴度（AT）降至安全水平是等待ABO血型不相容肝移植（ABOi LT）患者的必要前提条件。我们报告了在我们中心，在2种不同的血液分离平台（COBE Spectra和Spectra Optia）上对接受ABOi LT的患者进行级联血浆置换（CP）作为脱敏策略的经验。
本回顾性观察研究针对纳入ABOi LDLT脱敏方案的接受CP的患者进行。进行CP/传统治疗性血浆置换（每日/隔日，每日测定AT），直至达到目标滴度≤8。
在研究期间，4例患者（平均年龄46.7岁；100%为男性）接受了ABOi LDLT脱敏治疗，基线AT（IgM和IgG合并）范围为64至512。共进行了15次CP治疗（范围2 - 6次），每位患者中位数为3.5次。脱敏率为100%。仅1例患者在移植后因AT水平升至64（术后第8天）接受了传统治疗性血浆置换。术后平均住院时间为49天（范围30 - 105天）。所有患者均未经历任何排斥反应（重复肝活检）。随访（1年）时，2例患者存活且情况良好，而其他2例患者在住院期间因败血症死亡。
根据我们有限的经验，CP的使用对于接受ABOi LDLT的患者是一种安全有效的脱敏策略。
