When Push Comes to Shove! Emergency ABO-Incompatible Pediatric Living Donor Liver Transplant for Acute Wilson's Disease.
J Clin Exp Hepatol
; 12(2): 658-663, 2022.
Article
en En
| MEDLINE
| ID: mdl-35535085
ABSTRACT
ABO-incompatible living donor liver transplantation (ABOi-LDLT) is on the rise as a viable option in countries with limited access to deceased donor grafts. While reported outcomes of ABOi-LT in children are similar to ABO- Compatible liver transplant (ABOc-LT), most children beyond 1-2 years of age will need desensitization to overcome the immunological barrier of incompatible blood groups. The current standard protocol for desensitization is Rituximab that targets B lymphocytes and is given 2-3 weeks prior to LT. However, this timeline may not be feasible in children requiring emergency LT for acute liver failure (ALF) or acute-on-chronic liver failure (ACLF). In this emergency situation of ABOi-LT, a safe multipronged approach may be an acceptable alternative solution. We report a child with acute Wilson's disease with rapidly deteriorating liver function who underwent a successful ABOi-LDLT using a rapid desensitization protocol.
ABOc-LT, ABO-compatible liver transplantation (ABOi-LDLT); ABOi-LDLT, ABO-incompatible living donor liver transplantation; ACLF, Acute-on-chronic liver failure; ALF, Acute liver failure; AMR, Antibody-mediated rejection; CMV, Cytomegalovirus; CSF, Cerebrospinal fluid; GRWR, Graft-to-recipient weight ratio; LDLT, Living donor liver transplantation; LT, Liver transplant; MMF, Mycophenolate mofetil; PVT, Portal vein thrombosis; Rituximab; acute Wilson's disease; acute-on-chronic liver disease; emergency ABOi-LDLT; living donor liver transplantation
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2022
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