Background: ABO-incompatible (ABO-i) liver transplantation (LT) is a high-risk procedure due to the heightened potential for antibody mediated rejection (AMR). The aim of the current report is to illustrate the long-term results of the use of therapeutic plasma exchange (TPE) associated to high-dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO-i adult LT patients. Methods: Between January 1996 and December 2009, 20 patients underwent ABO-i LT at our Institution. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included 9 patients treated with TPE and IVIg. All group 2 patients received ECP. Results: At a median follow up of 66 months (range 0-103), the overall graft and patient survival at 1 month, 1 year and 5 years was 85%, 70%, 48.8% and 85%, 75%, 53.8%, respectively. Graft survival at 1 month, 1 year and 5 years was 81.8%, 54.5% and 27.3% for Group 1 (median follow up 31 months, range 0-121) versus 88.9%, 88.9% and 76.2% for Group 2 (median follow up 73 months, range 0-85) (p=0.03). Reasons for death are summarized in table 1. In Group 1 there were 3 (27.3%) cases of AMR, 5 (45.4%) biopsy proven acute rejection (BPAR), 1 (9.1%) chronic rejection and 3 (27.3%) non-anastomotic biliary stenosis (NABS). No cases of AMR, BPAR, chronic rejection or NABS were observed in Group 2. Table. Reasons of de... opens a modal window Table. Reasons of de... Conclusion: TPE in combination with IVIg and ECP appears to improve graft survival in adult ABO-i liver transplantation.
Long-term follow-up in ABO-incompatible adult liver transplantation
De Simone P;Leonardi G;Pezzati D;Filipponi F
2012-01-01
Abstract
Background: ABO-incompatible (ABO-i) liver transplantation (LT) is a high-risk procedure due to the heightened potential for antibody mediated rejection (AMR). The aim of the current report is to illustrate the long-term results of the use of therapeutic plasma exchange (TPE) associated to high-dose immunoglobulins (IVIg) and extracorporeal photopheresis (ECP) in ABO-i adult LT patients. Methods: Between January 1996 and December 2009, 20 patients underwent ABO-i LT at our Institution. Group 1 (control group) consisted of 11 patients treated with TPE only. Group 2 (study group) included 9 patients treated with TPE and IVIg. All group 2 patients received ECP. Results: At a median follow up of 66 months (range 0-103), the overall graft and patient survival at 1 month, 1 year and 5 years was 85%, 70%, 48.8% and 85%, 75%, 53.8%, respectively. Graft survival at 1 month, 1 year and 5 years was 81.8%, 54.5% and 27.3% for Group 1 (median follow up 31 months, range 0-121) versus 88.9%, 88.9% and 76.2% for Group 2 (median follow up 73 months, range 0-85) (p=0.03). Reasons for death are summarized in table 1. In Group 1 there were 3 (27.3%) cases of AMR, 5 (45.4%) biopsy proven acute rejection (BPAR), 1 (9.1%) chronic rejection and 3 (27.3%) non-anastomotic biliary stenosis (NABS). No cases of AMR, BPAR, chronic rejection or NABS were observed in Group 2. Table. Reasons of de... opens a modal window Table. Reasons of de... Conclusion: TPE in combination with IVIg and ECP appears to improve graft survival in adult ABO-i liver transplantation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
