ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study
Autor(a) principal: | |
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Data de Publicação: | 2013 |
Outros Autores: | , , , , , , , , , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10400.17/1241 |
Resumo: | INTRODUCTION: ABO-incompatible liver transplantation (ABOi LT) is considered to be a rescue option in emergency transplantation. Herein, we have reported our experience with ABOi LT including long-term survival and major complications in these situations. PATIENT AND METHODS: ABOi LT was performed in cases of severe hepatic failure with imminent death. The standard immunosuppression consisted of basiliximab, corticosteroids, tacrolimus, and mycophenolate mofetil. Pretransplantation patients with anti-ABO titers above 16 underwent plasmapheresis. If the titer was above 128, intravenous immunoglobulin (IVIG) was added at the end of plasmapheresis. The therapeutic approach was based on the clinical situation, hepatic function, and titer evolution. A rapid increase in titer required five consecutive plasmapheresis sessions followed by administration of IVIG, and at the end of the fifth session, rituximab. RESULTS: From January 2009 to July 2012, 10 patients, including 4 men and 6 women of mean age 47.8 years (range, 29 to 64 years), underwent ABOi LT. At a mean follow-up of 19.6 months (range, 2 days to 39 months), 5 patients are alive including 4 with their original grafts. One patient was retransplanted at 9 months. Major complications were infections, which were responsible for 3 deaths due to multiorgan septic failure (2 during the first month); rejection episodes (4 biopsy-proven of humoral rejections in 3 patients and 1 cellular rejection) and biliary. CONCLUSION: The use of ABOi LT as a life-saving procedure is justifiable in emergencies when no other donor is available. With careful recipient selection close monitoring of hemagglutinins and specific immunosuppression we have obtained acceptable outcomes. |
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ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center StudyTransplantação de FígadoFalência Hepática AgudaHCC NEFSistema do Grupo Sanguíneo ABOAnticorpos Monoclonais MurinosTerapêutica e DosagemImunoglobulinas IntravenosasImunossupressoresPlasmaferesePortugalHCC CIRHCC GASHCC UCIHCC HEMINTRODUCTION: ABO-incompatible liver transplantation (ABOi LT) is considered to be a rescue option in emergency transplantation. Herein, we have reported our experience with ABOi LT including long-term survival and major complications in these situations. PATIENT AND METHODS: ABOi LT was performed in cases of severe hepatic failure with imminent death. The standard immunosuppression consisted of basiliximab, corticosteroids, tacrolimus, and mycophenolate mofetil. Pretransplantation patients with anti-ABO titers above 16 underwent plasmapheresis. If the titer was above 128, intravenous immunoglobulin (IVIG) was added at the end of plasmapheresis. The therapeutic approach was based on the clinical situation, hepatic function, and titer evolution. A rapid increase in titer required five consecutive plasmapheresis sessions followed by administration of IVIG, and at the end of the fifth session, rituximab. RESULTS: From January 2009 to July 2012, 10 patients, including 4 men and 6 women of mean age 47.8 years (range, 29 to 64 years), underwent ABOi LT. At a mean follow-up of 19.6 months (range, 2 days to 39 months), 5 patients are alive including 4 with their original grafts. One patient was retransplanted at 9 months. Major complications were infections, which were responsible for 3 deaths due to multiorgan septic failure (2 during the first month); rejection episodes (4 biopsy-proven of humoral rejections in 3 patients and 1 cellular rejection) and biliary. CONCLUSION: The use of ABOi LT as a life-saving procedure is justifiable in emergencies when no other donor is available. With careful recipient selection close monitoring of hemagglutinins and specific immunosuppression we have obtained acceptable outcomes.ElsevierRepositório do Centro Hospitalar Universitário de Lisboa Central, EPEMendes, MFerreira, ACFerreira, ARemédio, FAires, ICordeiro, AMascarenhas, AMartins, APereira, PGlória, HPerdigoto, RVeloso, JFerreira, POliveira, JSilva, MBarroso, ENolasco, F2013-05-08T15:07:10Z20132013-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.17/1241engTransplant Proc. 2013 Apr;45(3):1110-5info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-03-10T09:30:33Zoai:repositorio.chlc.min-saude.pt:10400.17/1241Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T17:18:47.440929Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study |
title |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study |
spellingShingle |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study Mendes, M Transplantação de Fígado Falência Hepática Aguda HCC NEF Sistema do Grupo Sanguíneo ABO Anticorpos Monoclonais Murinos Terapêutica e Dosagem Imunoglobulinas Intravenosas Imunossupressores Plasmaferese Portugal HCC CIR HCC GAS HCC UCI HCC HEM |
title_short |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study |
title_full |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study |
title_fullStr |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study |
title_full_unstemmed |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study |
title_sort |
ABO-Incompatible Liver Transplantation in Acute Liver Failure: A Single Portuguese Center Study |
author |
Mendes, M |
author_facet |
Mendes, M Ferreira, AC Ferreira, A Remédio, F Aires, I Cordeiro, A Mascarenhas, A Martins, A Pereira, P Glória, H Perdigoto, R Veloso, J Ferreira, P Oliveira, J Silva, M Barroso, E Nolasco, F |
author_role |
author |
author2 |
Ferreira, AC Ferreira, A Remédio, F Aires, I Cordeiro, A Mascarenhas, A Martins, A Pereira, P Glória, H Perdigoto, R Veloso, J Ferreira, P Oliveira, J Silva, M Barroso, E Nolasco, F |
author2_role |
author author author author author author author author author author author author author author author author |
dc.contributor.none.fl_str_mv |
Repositório do Centro Hospitalar Universitário de Lisboa Central, EPE |
dc.contributor.author.fl_str_mv |
Mendes, M Ferreira, AC Ferreira, A Remédio, F Aires, I Cordeiro, A Mascarenhas, A Martins, A Pereira, P Glória, H Perdigoto, R Veloso, J Ferreira, P Oliveira, J Silva, M Barroso, E Nolasco, F |
dc.subject.por.fl_str_mv |
Transplantação de Fígado Falência Hepática Aguda HCC NEF Sistema do Grupo Sanguíneo ABO Anticorpos Monoclonais Murinos Terapêutica e Dosagem Imunoglobulinas Intravenosas Imunossupressores Plasmaferese Portugal HCC CIR HCC GAS HCC UCI HCC HEM |
topic |
Transplantação de Fígado Falência Hepática Aguda HCC NEF Sistema do Grupo Sanguíneo ABO Anticorpos Monoclonais Murinos Terapêutica e Dosagem Imunoglobulinas Intravenosas Imunossupressores Plasmaferese Portugal HCC CIR HCC GAS HCC UCI HCC HEM |
description |
INTRODUCTION: ABO-incompatible liver transplantation (ABOi LT) is considered to be a rescue option in emergency transplantation. Herein, we have reported our experience with ABOi LT including long-term survival and major complications in these situations. PATIENT AND METHODS: ABOi LT was performed in cases of severe hepatic failure with imminent death. The standard immunosuppression consisted of basiliximab, corticosteroids, tacrolimus, and mycophenolate mofetil. Pretransplantation patients with anti-ABO titers above 16 underwent plasmapheresis. If the titer was above 128, intravenous immunoglobulin (IVIG) was added at the end of plasmapheresis. The therapeutic approach was based on the clinical situation, hepatic function, and titer evolution. A rapid increase in titer required five consecutive plasmapheresis sessions followed by administration of IVIG, and at the end of the fifth session, rituximab. RESULTS: From January 2009 to July 2012, 10 patients, including 4 men and 6 women of mean age 47.8 years (range, 29 to 64 years), underwent ABOi LT. At a mean follow-up of 19.6 months (range, 2 days to 39 months), 5 patients are alive including 4 with their original grafts. One patient was retransplanted at 9 months. Major complications were infections, which were responsible for 3 deaths due to multiorgan septic failure (2 during the first month); rejection episodes (4 biopsy-proven of humoral rejections in 3 patients and 1 cellular rejection) and biliary. CONCLUSION: The use of ABOi LT as a life-saving procedure is justifiable in emergencies when no other donor is available. With careful recipient selection close monitoring of hemagglutinins and specific immunosuppression we have obtained acceptable outcomes. |
publishDate |
2013 |
dc.date.none.fl_str_mv |
2013-05-08T15:07:10Z 2013 2013-01-01T00:00:00Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10400.17/1241 |
url |
http://hdl.handle.net/10400.17/1241 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Transplant Proc. 2013 Apr;45(3):1110-5 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Elsevier |
publisher.none.fl_str_mv |
Elsevier |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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