Feasibility of Immunoadsorption plasmapheresis in an infant for ABO-incompatible solid organ transplant-A reality.
Pediatr Transplant
; 25(7): e14064, 2021 Nov.
Article
in En
| MEDLINE
| ID: mdl-34057793
ABSTRACT
BACKGROUND:
Immunoadsorption (IA) plasmapheresis is standard modality for pretransplant desensitization in ABO-incompatible solid organ transplants though technically challenging when considered for an infant or a child less than 10 kg due to non-availability of pediatric immunoadsorption (IA) columns. The major challenge is to maintain hemodynamic stability considering the large extracorporeal circuit volume meant for adults. To our best knowledge after extensive search in acclaimed global medical journals, this is the first successful attempt in an underweight (6 kg) infant of less than 1 year of age using adult size IA Column thus making it a reality. CASE CHARACTERISTICS We report an 8-month-old male infant (A positive) of 6 kg with decompensated liver disease secondary to extrahepatic biliary atresia requiring urgent live donor liver transplantation with AB positive donor with significantly elevated pretransplant anti-B IgG/ IgM antibody titers >11024. Baby underwent multiple sessions of anti-B immunoadsorption plasmapheresis to lower anti-B IgM / IgG titers using available adult anti-B immunoadsorption column. Postprocedure, the antibody titers reduced to 18 (anti-IgG) 116 (anti-IgM) followed by successful ABO-incompatible live donor liver transplant (LDLT).OUTCOME:
Anti-B titers remained in normal range in the immediate and post-transplant period with satisfactory liver functions and no rejection.CONCLUSION:
Immunoadsorption plasmapheresis for ABO-incompatible solid organ transplantation in infants gives desirable results and can be offered to small sized infants using currently available adult sized IA columns when conducted with adequate technical expertise.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Blood Group Incompatibility
/
ABO Blood-Group System
/
Biliary Atresia
/
Liver Transplantation
/
Plasmapheresis
Limits:
Humans
/
Infant
/
Male
Language:
En
Journal:
Pediatr Transplant
Journal subject:
PEDIATRIA
/
TRANSPLANTE
Year:
2021
Document type:
Article
Affiliation country: