Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia

Yohei Yamada, Ken Hoshino, Yasuhide Morikawa, Jun Okamura, Ryo Hotta, Koji Komori, Shioko Nakao, Hideaki Obara, Shigeyuki Kawachi, Yasushi Fuchimoto, Minoru Tanabe, Motohide Shimazu, Masaki Kitajima

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Background: The problem of ABO-incompatible liver transplantation still remains unsolved in older children. In this article, we report on our experience of 6 successful ABO-incompatible liver transplantations in patients with biliary atresia. Material and Methods: Six patients (ABO incompatibility type A→O:1 case, B→O:2 cases, A→B:3 cases) were enrolled in this study; 3 patients were aged approximately 1 year and the other 3 ranged in age from 9 to 24 years at the time of transplantation. Each patient received perioperative plasma exchange, until the anti-donor blood-type antibody titers became less than 1:16, and also systemic multidrug immunosuppressive therapy (cyclophosphamide, prednisolone, and tacrolimus). We applied the protocol of intraportal infusion therapy (local administration of prostaglandin E1, steroid, and gabexate mesilate via a portal vein catheter), splenectomy, and rituximab administration for the older group. Results: Both the patient and graft survival rates remain at 100%, with the follow-up period of the patients ranging from 12 and 123 months. Acute cellular rejection occurred in 2 cases, and both were steroid sensitive. There was no incidence of humoral rejection. Although all cases developed viral infection, all recovered uneventfully with the administration of antiviral agents. Conclusion: ABO-incompatible liver transplantation can be performed with a low risk of humoral rejection or late biliary complications using this combined antirejection strategy, even in older children.

Original languageEnglish
Pages (from-to)1976-1979
Number of pages4
JournalJournal of Pediatric Surgery
Issue number12
Publication statusPublished - 2006 Dec


  • ABO incompatible liver transplantation
  • Children
  • Humoral rejection
  • Intraportal infusion therapy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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