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Journal of Transplantation
Volume 2009 (2009), Article ID 759581, 8 pages
http://dx.doi.org/10.1155/2009/759581
Clinical Study

Adult Living Donor Liver Transplantation with ABO-Incompatible Grafts: A German Single Center Experience

1Department of General and Visceral Surgery, University Medical Center Göttingen, 37099 Göttingen, Germany
2Department of Surgery, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
3Department of Hepatobiliary and Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
4Department of Gastroenterology, University Medical Center Göttingen, 37099 Göttingen, Germany

Received 24 July 2009; Accepted 18 October 2009

Academic Editor: Bernhard K. Krämer

Copyright © 2009 Armin D. Goralczyk et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Adult living donor liver transplantations (ALDLTs) across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins) were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR). Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety.