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Zero Mortality Using Graft-to-recipient Weight Ratio Less Than 0.6% in Adult Living Donor Liver Transplantation: Overcoming Small-for-size Syndrome by Wong, Tiffany CL.; Ng, Kelvin; Dai, Jeff; Chok, Kenneth; Chan, Albert; Cheung, Tan-to; Lo, Chung Mau is a Medicine article available to read on EtoBox.

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Characteristics: median (range): Male/female; 59/48, Recipient age; 53 (17w69) y/o, Donor age; 47(21w66) y/o, MELD; 18(8-55), Graft weight; 530(230w1025)g, GRWR; 0.85 (0.54w1.55)%. Splenectomy was performed in 61cases(57%). Result: Patients with AMR(n=28) showed lower survival. Era3 achieved the best overall survival. Splenectomy did not have any impact on survival after ABO-I LDLT. One patient was introduced Bortezomib, who showed uncontrollable AMR on POD 7, and was rescued without any complication. Pretransplant anti-AB antibody (IgG)32, and posttransplant anti-AB antibody (IgG and IgM)16 showed significantly higher rate of AMR. Eight cases showed ischemic cholangiopathy, in which 6 cases(75%) showed graft failure. RIX administration within one week before LDLT showed higher rate of AMR. Conclusion: Besides the results of our current strategy against ABO-I LDLT is not satisfactory, followings are recommended; (1) Reduce pretransplant anti-ABO antibody IgG< 32titer (2) In case of the anti-AB antibody 16titer after LDLTx, beware AMR (3) Against uncontrollable AMR, consider to use Bortezomib. (4) Posttransplant cholangiography is important to check the ischemic cholangiopathy.

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Author

Wong, Tiffany CL.; Ng, Kelvin; Dai, Jeff; Chok, Kenneth; Chan, Albert; Cheung, Tan-to; Lo, Chung Mau

Publisher

John Wiley and Sons; Elsevier ; Elsevier Limited; Elsevier BV; Wiley (ISSN 1365-182X)

Published

2019

Language

EN

Field

Medicine (Health Sciences)