Dual Living Donor Liver Transplantation with ABO-Incompatible and ABO-Compatible Grafts to Overcome Small-for-Size Graft and ABO Blood Group Barrier

摘要

ABO blood group compatibility has been regarded as an essential prerequisite for successful adult living donor liver trans-plantation (LDLT). Novel strategies for overcoming the ABO blood group barrier, however, have markedly improved theresults of ABO-incompatible (ABOi) LDLT. We describe our strategies for dual graft LDLT to cope with ABO-incompatibilityand small-for-size graft syndrome in 3 patients who underwent dual graft LDLT with ABOi and ABO-compatible (ABOc)grafts. One patient received a modified right lobe graft from an ABOi living donor and a left lateral section graft from anABOc deceased donor, whereas the other 2 patients received 2 left lobe or left lateral section grafts from ABOi and ABOcliving donors. To overcome the ABO-blood barrier, each patient was treated with preoperative anti-CD20 antibody (rituximab375 mg/m2), perioperative plasma exchange, and hepatic arterial infusion. All 3 patients were males, of mean age 47.7years (range, 4052 years) and mean Model for End-Stage Liver Disease score 12.3 (range, 9-15). The mean graft-to-re-cipient weight ratio was 0.99%. All patients remain alive after a mean follow-up period of 9.5 months (range, 8.0-40.7months). All 6 grafts have functioned normally. There were no episodes of antibody-mediated rejection or biliary complica-tion. Dual LDLT with ABOi and ABOc grafts can be a feasible solution for simultaneously overcoming both the ABO bloodgroup barrier and small-for-size graft syndrome.