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      Simultaneous ABO-incompatible living-donor liver transplantation and splenectomy without plasma exchange in China: Two case reports

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          Abstract

          ABO-incompatible (ABO-i) living-donor liver transplantation (LDLT) is performed if an ABO-compatible graft cannot be obtained. However, a perfect desensitization protocol has not been established worldwide, especially for simultaneous ABO-i LDLT and splenectomy. We herein report two cases of ABO-i LDLT. To the best of our knowledge, this is the first case report of ABO-i LDLT in an adult patient in China. Splenectomy and T-cell-targeted immunosuppression (basiliximab) was used to overcome the blood group barrier in these recipients. The patients had good graft function without signs of antibody-mediated rejection throughout the 12-month follow-up. Thus, ABO-i LDLT with splenectomy is undoubtedly life-saving when an ABO-compatible graft cannot be obtained for patients in critical condition.

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          ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor.

          Choon Kwon, Jae-Won Joh, Eun-Suk Kang … (2013)
          ABO-incompatible liver transplantation is usually contraindicated because of the risk of antibody-mediated humoral rejection of the graft. We describe 22 successful cases of patients who had living donor liver transplantation (LDLT) from ABO-incompatible donors.
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            Risk factors for early bacterial infections in liver transplantation.

            İlkay T. Unek, H Köse, M. Kemal Özbilgin … (2013)
            Our aim was to determine perioperative risk factors for early bacterial infection after liver transplantation. Retrospectively examining medical records using Centers for Disease Control and Prevention (CDC) definitions to identify nosocomial infections, we analyzed data on 367 adult patients. The incidence of infection was 37.3% (n = 137): namely, surgical site (n = 74; 20.2%) [corrected], blood stream (n = 64; 17.4%), pulmonary (n = 49; 13.4%), urinary system (n = 26; 7.1%). Significant risk factors within the first 30 days were as follows: deceased donor, Model for End-Stage Liver Disease (MELD) >20, albumin level 6 U, intraoperative fresh frozen plasma >12 U, bilioenteric anastomosis, postoperative intensive care unit stay >6 days, and postoperative length of stay >21 days. Significant risk factors detected within the first 90 days were as follows: MELD >20, preoperative length of stay >7 days, reoperation, postoperative length of intensive care unit stay >6 days, and postoperative length of stay >21 days. Variability was observed in risk factors according to localization of infection. As a result, except for MELD, type of donor, and biliary anastomosis, the others are preventable factors for early bacterial infection. In addition, the same risk factors showed variability according to the site of infection. Copyright © 2013 Elsevier Inc. All rights reserved.
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              Splenectomy is not indicated in living donor liver transplantation.

              Kyoji Ito, Nobuhisa Akamatsu, Akihiko Ichida … (2016)
              Simultaneous splenectomy (SPX) is preferentially performed in living donor liver transplantation (LDLT) to modulate portal flow; increase postoperative platelet count, especially among those with hepatitis C virus (HCV) infection; and modulate the immunologic status in ABO-incompatible cases. The negative effects of the procedure, however, are not well established. Records of 395 LDLTs performed at our institution, including 169 (42.8%) patients with simultaneous SPX and 226 (57.2%) patients with spleen preservation, were reviewed with special reference to the simultaneous SPX cases. The most common indication for SPX was HCV-related disease (n = 114), followed by low preoperative platelet count (n = 52), and other reasons (n = 3). Simultaneous splenectomy did not increase the platelet count in the early postoperative period, but the incidence of reoperation for postoperative hemorrhage was increased, mainly at the SPX site, within the first week. In addition, the operative time, intraoperative blood loss, and incidence of lethal infectious disease were significantly higher in the SPX group, whereas the incidence of small-for-size syndrome was comparable between groups. Finally, SPX was an independent predictor for both postoperative hemorrhage (odds ratio [OR] = 2.451; 95% confidence interval [CI] = 1.285-4.815; P = 0.006) and lethal infectious complication (OR = 3.748; 95% CI = 1.148-14.001; P = 0.03). In conclusion, on the basis of the present findings, we do not recommend simultaneous SPX in LDLT. Liver Transplantation 22 1526-1535 2016 AASLD.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Int Med Res
                Journal ID (iso-abbrev): J. Int. Med. Res
                Journal ID (publisher-id): IMR
                Journal ID (hwp): spimr
                Title: The Journal of International Medical Research
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Print): 0300-0605
                ISSN (Electronic): 1473-2300
                Publication date (Electronic): 21 June 2017
                Publication date (Print): December 2017
                Volume: 45
                Issue: 6
                Pages: 2146-2152
                Affiliations
                [1 ]Department of Hepatobiliary and Pancreatic Surgery, People’s Hospital, Zhengzhou University, Zhengzhou, China
                [2 ]Department of Hepatobiliary and Pancreatic Surgery, Zhengzhou People’s Hospital, Southern Medical University, Zhengzhou, China
                Author notes
                [*]Sidong Wei, Department of Hepatobiliary and Pancreatic Surgery, People’s Hospital, Zhengzhou University, 7 Weiwu Road, Jinshui District, Zhengzhou 450003, China. Email: weisidongyishi@ 123456126.com
                Article
                Publisher ID: 10.1177_0300060517710407
                DOI: 10.1177/0300060517710407
                PMC ID: 5805207
                PubMed ID: 28635356
                SO-VID: 7813c1a1-d9b6-4b0b-97c9-25489fec9285
                Copyright © © The Author(s) 2017
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License ( http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 15 November 2016
                Date accepted : 26 April 2017
                Categories
                Subject: Case Report

                Keywords: abo-incompatible transplantation,living-donor transplantation,liver transplantation,splenectomy,treatment
                Data availability:
                Keywords: abo-incompatible transplantation, living-donor transplantation, liver transplantation, splenectomy, treatment

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