Successful Adult ABO Incompatible Living Donor Liver Transplantation: Experience with Double Infusion through the Hepatic Artery and Portal Vein

Background/Aims: Multiple immunosuppressants, plasma exchanges (PEs), splenectomy, and/or local infusion therapy (either hepatic artery (HA) or portal vein (PV) infusion) are needed in patients undergoing ABO-incompatible living donor liver transplantation (LDLT). Local infusion therapy is commonly undertaken using the single route, and double-infusion therapy has scarcely been investigated. Herein, we describe our experience with five ABO-incompatible LDLT patients who received double-infusion therapy via both the HA and PV. Methodology: Five patients (age 43-67 years, with HBV, HBV+HCC, HCV+HCC, PBC, cryptogenic) underwent ABO-incompatible LDLT. Following multiple PEs, LDLT with splenectomy was performed. Triple-immunosuppressant and double-infusion therapy, namely, methylprednisolone and PGE1 via the HA and gabexate mesilate via the PV were employed. Results: All five patients achieved accommodation (22-66 months). One patient experienced transient AMR, and recovered after PE and intraarterial steroid infusion. Four of the five patients experienced PV mural thrombi near the PV catheter and recovered with pharmacological treatment. Conclusion: Thus, double-infusion therapy could also be useful for ABO-incompatible LDLT under control against PV mural thrombi.