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World J Transplant. Sep 24, 2016; 6(3): 548-555
Published online Sep 24, 2016. doi: 10.5500/wjt.v6.i3.548
Current techniques for AB0-incompatible living donor liver transplantation
Silke Rummler, Astrid Bauschke, Erik Bärthel, Heike Jütte, Katrin Maier, Patrice Ziehm, Christina Malessa, Utz Settmacher
Silke Rummler, Heike Jütte, Katrin Maier, Patrice Ziehm, Institute of Transfusion Medicine, University Hospital Jena, 07747 Jena, Germany
Astrid Bauschke, Erik Bärthel, Christina Malessa, Utz Settmacher, Department of General, Visceral and Vascular Surgery, University Hospital Jena, 07747 Jena, Germany
Author contributions: Rummler S and Bauschke A conducted the research and wrote the paper; Bärthel E, Jütte H, Maier K, Ziehm P and Malessa C collected and analyzed data; Settmacher U contributed important content-related arguments and revised the manuscript critically; Rummler S and Bauschke A contributed equally.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Astrid Bauschke, MD, Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, 07740 Jena, Germany. astrid.bauschke@med.uni-jena.de
Telephone: +49-3641-9322454 Fax: +49-3641-9322602
Received: March 28, 2016
Peer-review started: April 1, 2016
First decision: May 23, 2016
Revised: June 24, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: September 24, 2016
Processing time: 179 Days and 10.5 Hours
Abstract

For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible (AB0i) grafts. Improvements in AB0i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0i living donor liver transplantation (LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients’ graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0i LDLT is a feasible option today and almost free of severe complications.

Keywords: Living-donor liver transplantation; AB0-incompatible; Rituximab; Desensitization; Iso-titer; Biliary complications

Core tip: Due to refined treatment strategies, AB0-incompatible living donor liver transplantation (AB0i LDLT) is a feasible option today and almost free from severe complications, but biliary complications still affect the quality of life after AB0i LDLT. Until now, the best improvement could be reached with the prophylactic use of rituximab more than one week before AB0i LDLT.