Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation

Background. ABO-incompatible liver transplantation is associated with an extremely complicated postoperative course, especially when the recipients are adults. Methods. Two adult patients underwent living-donor liver transplantation from ABO-incompatible donors. The antirejection therapy included multiple perioperative plasmapheresis, splenectomy, systemic triple immunosuppressive regimen with tacrolimus, methylprednisolone, and cyclophophamide, or azathioprine. In addition to these conventional approaches, we performed intraportal infusion therapy after transplantation with methylprednisolone, prostaglandin E, and gabexate mesilate. Results. With our protocol, antidonor blood group antibody titers in both cases remained low without any evidence of rejection or vascular complications throughout the postoperative course. Biliary complications were transient and resolved completely. The patients have now survived 30 and 12 months post-transplantation and have regained normal life activity with good liver function. Conclusions. Our experience has shown the feasibility of controlling rejection and other complications in adult ABO-incompatible liver transplantation under intraportal infusion therapy.