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Chapter-23 ABO-Incompatible Liver Transplantation

BOOK TITLE: Liver Transplantation

Author
1. K Dilip Chakravarty
2. Lee WC
3. Jan YY
4. Lee Po-Huang
ISBN
9788184487701
DOI
10.5005/jp/books/10445_23
Edition
1/e
Publishing Year
2010
Pages
6
Author Affiliations
1. Chang Gung Memorial Hospital (Linkou), Taipei, Taiwan (ROC)
2. Chang Gung Transplantation Institute (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
3. Chang Gung Memorial Hospital (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
4. National Taiwan University Hospital, Taipei, Taiwan (ROC)
Chapter keywords

Abstract

Living donor liver transplantation has been established as a treatment for patients with ESLD. But as donor selection is limited to mostly to relatives and spouses, concept of ABO incompatibility is developed to meet the demands of donor shortage. In the 1970s, the liver was considered a privileged organ because no hyperacute rejections had been observed when the ABO barrier was crossed. But later the concept about ABO barrier in LTX has changed with advances in understanding the immunology of liver transplantation. LDLT using an ABO-I donor has been reserved as the only available option for saving the life of a patient who only has ABO-I donors. The first ABO-I LDLT was performed in November 1991 in Japan. In Japan national registry for ABO incompatible transplantation was established in 2001. The main reason for these poor results is the severe hyperacute rejection due to anti-donor antibodies during the early postoperative period. The impact of preformed anti-donor antibodies and the strategy to reduce their titers play key roles in the success of this form of transplantation. Liver transplantation across the ABO blood type barrier (ABO-incompatible) is usually contraindicated earlier or is exceptionally performed only as a rescue option in an emergency situation because of the possibility of graft loss caused by antibody mediated rejection.

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