ABO INCOMPATIBLE (ABOI) LIVER TRANSPLANT IN CHILDREN
An 18-month-old child came to us with chronic liver disease/portal hypertension. He underwent ABO incompatible living donor liver transplant in April in view of lack of matched donor. The child was extubated soon and had uneventful ICU stay. He recovered well post operatively with standard immunosuppression and supportive medications. There were no biliary or vascular complications. He was discharged after 2 weeks of surgery.
Liver transplantation has been established as an effective treatment for end-stage liver disease (cirrhosis). Donor shortage has been a serious problem globally. In several countries including India, living donor liver transplantation (LDLT) remains a major modality because of limited availability of cadaveric donor organs. Liver grafts from ABO-incompatible (ABOi) donors have been used to address the donor shortage and to increase the possibilities of liver transplantation.
Strategies in ABOi LDLT using plasmapheresis/immunoadsorption; anti-CD20 monoclonal antibody, rituximab; and B-cell desensitization with intravenous immunoglobulin have made it a viable option over the last few years. The high incidence of antibody-mediated rejection (AMR) in addition to the usual cell mediated rejection, remains an issue that one should be vigilant. In addition, several studies have shown higher incidence of biliary stricture and vascular complications post-transplant. Most centres including ours use the standard immunosuppression and have shown low incidence of rejection and good patient and graft survival.
Dr. Deepak Goel
Dr. Deepak Goyal, a Pediatric Gastroenterologist with extensive post-MD experience of more than 15 years that includes super-specialty training in ‘Pediatric Hepatology & Gastroenterology’ (MCI-recognized) at SGPGIMS, Lucknow, has managed various kinds of complicated Pediatric Gastroenterology, Hepatology & Liver Transplant Cases.
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