TY - JOUR
T1 - ABO-incompatible liver transplantation for children under 2 years of age
T2 - A case report and a single-center review
AU - Narumoto, Soichi
AU - Sakamoto, Seisuke
AU - Sasaki, Kengo
AU - Hirata, Yoshihiro
AU - Fukuda, Akinari
AU - Uchiyama, Toru
AU - Irie, Rie
AU - Yoshioka, Takako
AU - Kasahara, Mureo
N1 - Publisher Copyright:
© 2018 Wiley Periodicals, Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Desensitization with RTX has been broadly introduced in adult LT across the ABO blood type barrier. For pediatric LT, the prophylactic use of RTX has not been standardized, especially for children under 2 years of age. A 20-month-old girl with BA underwent living donor LT from her ABO-I mother. On POD 6, she developed combined T cell-mediated and AMRs. Steroid bolus injection was immediately introduced, followed by antibody-depleting therapy with PE and IVIG. Based on a peripheral blood lymphocyte analysis by fluorescence-activated cell sorting, ATG and RTX were introduced for refractory rejection. Although she recovered from the combined rejections, IHBCs were inevitable as a consequence. We recommend extending the desensitization protocol to cover children under 2 years of age in order to prevent life-threatening complications.
AB - Desensitization with RTX has been broadly introduced in adult LT across the ABO blood type barrier. For pediatric LT, the prophylactic use of RTX has not been standardized, especially for children under 2 years of age. A 20-month-old girl with BA underwent living donor LT from her ABO-I mother. On POD 6, she developed combined T cell-mediated and AMRs. Steroid bolus injection was immediately introduced, followed by antibody-depleting therapy with PE and IVIG. Based on a peripheral blood lymphocyte analysis by fluorescence-activated cell sorting, ATG and RTX were introduced for refractory rejection. Although she recovered from the combined rejections, IHBCs were inevitable as a consequence. We recommend extending the desensitization protocol to cover children under 2 years of age in order to prevent life-threatening complications.
KW - ABO-incompatible
KW - antibody-mediated rejection
KW - fluorescence-activated cell sorting
KW - pediatric living donor liver transplantation
KW - Rituximab
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U2 - 10.1111/petr.13308
DO - 10.1111/petr.13308
M3 - Article
C2 - 30341789
AN - SCOPUS:85055275954
SN - 1397-3142
VL - 23
JO - Pediatric Transplantation
JF - Pediatric Transplantation
IS - 1
M1 - e13308
ER -