The critical role of therapeutic plasma exchange in ABO-incompatible liver transplantation
Cheng-Zuo Han a,b , Qiang Wei a,b,c , Meng-Fan Yang a,b , Li Zhuang d , Xiao Xu a ,b ,c ,*
a Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
b Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China
c National Center for Healthcare Quality Management in Liver Transplant, Hangzhou 310003, China
d Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310022, China
∗Corresponding author at: Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
E-mail address: zjxu@zju.edu.cn (X. Xu) .
Abstract：Background: The shortage of donor liver restricts liver transplantation (LT). Nowadays, donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver. Although it is now possible to perform ABO-incompatible (ABO-I) LT, antibody-mediated rejection (AMR) has been recognized as the primary cause of desperate outcomes after ABO-I LT. Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury. Therapeutic plasma exchange (TPE) can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.
Data sources: We searched PubMed and CNKI databases using search terms “therapeutic plasma exchange”, “ABO-incompatible liver transplantation”, “ABO-I LT”, “liver transplantation”, “LT”, “antibody-mediated rejection”, and “AMR”. Additional publications were identified by a manual search of references from key articles. The relevant publications published before September 30, 2020 were included in this review.
Results: Different centers have made different attempts on whether to use TPE, when to use TPE and how often to use TPE. However, the control standard of lectin revision level is always controversial, the target titer varies significantly from center to center, and the standard target titer has not yet been established. TPE has several schemes to reduce antibody titers, but there is a lack of clinical trials that provide standardized procedures.
Conclusions: TPE is essential for ABO-I LT. Hence, further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.
2022, Vol. 21 
