Cascade plasmapheresis as a desensitization strategy for patients undergoing ABO incompatible living donor liver transplantation (ABOi LDLT): A single center experience

被引:6
作者
Bajpai, Meenu [1 ]
Kakkar, Brinda [1 ]
Gupta, Shruti [1 ]
Rastogi, Archana [2 ]
Pamecha, Viniyendra [3 ]
机构
[1] Inst Liver & Biliary Sci, Dept Transfus Med, New Delhi 110070, India
[2] Inst Liver & Biliary Sci, Dept Pathol, New Delhi 110070, India
[3] Inst Liver & Bihar, Dept Liver Transplant Surg, New Delhi 110070, India
关键词
Cascade plasmapheresis; Desensitization; ABO incompatible; Liver transplantation; Antibody titers; APHERESIS THERAPY; ANTIBODY;
D O I
10.1016/j.transci.2019.04.028
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background and aim: The reduction of antibody titres (Ars) to a safe level is essential pre-requisite for patients awaiting ABO-incompatible liver transplantation (ABOi LT). We report our experience of performing cascade plasmapheresis (CP) on 2 different apheresis platforms (COBE Spectra and Spectra Optia) as a desensitization strategy for patients undergoing ABOi LT in our centre. Methods: This retrospective observational study was conducted on patients who underwent CP included in the desensitization protocol for ABOi LDLT. CP/conventional TPE was performed (daily/alternate day with daily estimation of AT) until a target titre of <= 8 was achieved. Results: During the study period, 4 patients (mean age 46.7 years; 100% males) underwent desensitization for ABOi LDLT with baseline AT (combined IgM and IgG) ranging from 64 to 512. A total of 15 CP sessions (range 2 - 6) were performed with a median of 3.5 sessions/patient. Desensitization rate was 100%. Only 1 patient underwent conventional TPE in the post-transplant due to rise in AT level to 64 (post-operative day 8). Average post-operative length of stay was 49 days (range 30 - 105). None of the patients experienced any episode of rejection (repeat liver biopsy). On follow up (1 year), 2 patients were alive and doing well, while other 2 patients succumbed during their hospital stay due to sepsis. Conclusion: In our limited experience, the use of CP was safe and effective desensitization strategy for patients undergoing ABOi LDLT.
引用
收藏
页码:442 / 446
页数:5
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