Feasibility of ABO-incompatible adult living donor liver transplantation for acute-on-chronic liver failure
Seok-Hwan Kim, Gi-Won Song, Shin Hwang, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha and Sung-Gyu Lee
Seok-Hwan Kim, Gi-Won Song, Shin Hwang, Chul-Soo Ahn, Deok-Bog Moon, Tae-Yong Ha and Sung-Gyu Lee
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea (Kim SH, Song GW, Hwang S, Ahn CS, Moon DB, Ha TY and Lee SG)
Corresponding Author: Gi-Won Song
(Email: drsong71@amc.seoul.kr)
Abstract：To the Editor:
In Korea, the annual number of deceased donors for organ transplantation per million people is still less than 10. Thus, approximately 40% of patients with acute liver failure or acute-on-chronic liver failure undergo living donor liver transplantation (LDLT).[1] Although the use of ABO-incompatible (ABOi) living donors is an attractive option, ABOi LDLT has very restricted applications for expanding the donor pool.[2] The main reason for its limited application is the considerable time required for desensitization using the anti-CD20 monoclonal antibody, rituximab (RIT), and total plasma exchange (TPE). For the effective suppression of B-cell activity, most protocols usually require the administration of RIT for 2-3 weeks prior to LDLT.[2] Although the impact of TPE on the pharmacokinetics of RIT is not well known in the LDLT setting, very early initiation of TPE immediately after RIT infusion significantly reduces the plasma concentration of RIT. Therefore, a certain waiting interval between RIT administration and TPE might be a more rational approach for preventing the post-LDLT rebound rise in the B-cell count and isoagglutinin titer, which may render ABOi LDLT unsuitable for patients requiring urgent LDLT.
2017, Vol. 16 
