Living donor liver transplantation for patients immunized against human leukocyte antigen.

Abstract

BACKGROUND/PURPOSE:

The clinical features and perioperative management of liver transplant recipients who are already sensitized against human leukocyte antigen (HLA) prior to transplantation are not yet clear.

MATERIALS AND METHODS:

Medical records of living donor liver transplant recipients were reviewed and clinical features of the patients possessing anti-HLA antibodies were studied.

RESULTS:

Among the 470 consecutive living donor liver transplant recipients, 6 patients (1.3%) had preformed anti-HLA antibodies. A review of the postoperative courses of these patients revealed that the problems included platelet transfusion refractoriness (PTR) due to immune-mediated destruction of platelet and thrombotic microangiopathy (TMA). PTR was observed in patients with anti-HLA class I antibodies and only HLA-matched platelet concentrate (HLA-matched PC) relieved thrombocytopenia. Intravenous gammaglobulin had an additive effect to HLA-matched PC in some cases, and platelet transfusion from close relatives might be a substitute for HLA-matched PC in life-threatening situations. Although the etiology of TMA is unremarkable, the incidence was high (67%, 4/6) compared with that in patients who were not sensitized against HLA (5.6%, 26/464; p < 0.01). Of the four patients, three were complicated with late-onset TMA.

CONCLUSIONS:

Considering these clinical features, careful preparation and postoperative management are needed for liver transplant candidates with anti-HLA antibodies.

• Authors: Junichi Shindoh, Yasuhiko Sugawara, Sumihito Tamura, Junichi Kaneko, Noriyo Yamashiki, Taku Aoki, Kiyoshi Hasegawa, Yoshihiro Sakamoto, Norihiro Kokudo
• Journal: Journal of hepato-biliary-pancreatic sciences (J Hepatobiliary Pancreat Sci) Vol. 20 Issue 3 Pg. 279-85 (Mar 2013) ISSN: 1868-6982 [Electronic] Japan
• PMID: 22407193 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antigens, Human Platelet
• HLA Antigens
• Immunoglobulins, Intravenous

Topics

• Adult
• Antigens, Human Platelet (immunology)
• Enzyme-Linked Immunosorbent Assay
• Fatal Outcome
• Female
• HLA Antigens (immunology)
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Liver Transplantation (immunology)
• Living Donors
• Male
• Middle Aged
• Platelet Transfusion
• Postoperative Complications (immunology)
• Thrombotic Microangiopathies (immunology)
• Treatment Outcome