ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes

Krupa R. Mysore; Ryan W. Himes; Abbas Rana; Jun Teruya; Moreshwar S. Desai; Poyyapakkam R. Srivaths; Kimberly Zaruca; Andrea Calvert; Danielle Guffey; Charles G. Minard; Eda Morita; Lisa Hensch; Michael Losos; Vadim Kostousov; Shiu Ki Rocky Hui; Jordan S. Orange; John A. Goss; Sarah K. Nicholas

doi:10.1111/petr.13263

ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes

Krupa R. Mysore, Ryan W. Himes, Abbas Rana, Jun Teruya, Moreshwar S. Desai, Poyyapakkam R. Srivaths, Kimberly Zaruca, Andrea Calvert, Danielle Guffey, Charles G. Minard, Eda Morita, Lisa Hensch, Michael Losos, Vadim Kostousov, Shiu Ki Rocky Hui, Jordan S. Orange, John A. Goss, Sarah K. Nicholas

Research output: Contribution to journal › Article › peer-review

21 Scopus citations

Abstract

ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.

Original language	English (US)
Article number	e13263
Journal	Pediatric Transplantation
Volume	22
Issue number	7
DOIs	https://doi.org/10.1111/petr.13263
State	Published - Nov 2018

Keywords

ABO incompatible
deceased donor
immunosuppression
isohemagglutinin
liver transplant
pediatric
plasmapheresis

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Transplantation

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10.1111/petr.13263

Cite this

Mysore, K. R., Himes, R. W., Rana, A., Teruya, J., Desai, M. S., Srivaths, P. R., Zaruca, K., Calvert, A., Guffey, D., Minard, C. G., Morita, E., Hensch, L., Losos, M., Kostousov, V., Hui, S. K. R., Orange, J. S., Goss, J. A., & Nicholas, S. K. (2018). ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes. Pediatric Transplantation, 22(7), Article e13263. https://doi.org/10.1111/petr.13263

Mysore, KR, Himes, RW, Rana, A, Teruya, J, Desai, MS, Srivaths, PR, Zaruca, K, Calvert, A, Guffey, D, Minard, CG, Morita, E, Hensch, L, Losos, M, Kostousov, V, Hui, SKR, Orange, JS, Goss, JA & Nicholas, SK 2018, 'ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes', Pediatric Transplantation, vol. 22, no. 7, e13263. https://doi.org/10.1111/petr.13263

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title = "ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes",

abstract = "ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.",

keywords = "ABO incompatible, deceased donor, immunosuppression, isohemagglutinin, liver transplant, pediatric, plasmapheresis",

author = "Mysore, {Krupa R.} and Himes, {Ryan W.} and Abbas Rana and Jun Teruya and Desai, {Moreshwar S.} and Srivaths, {Poyyapakkam R.} and Kimberly Zaruca and Andrea Calvert and Danielle Guffey and Minard, {Charles G.} and Eda Morita and Lisa Hensch and Michael Losos and Vadim Kostousov and Hui, {Shiu Ki Rocky} and Orange, {Jordan S.} and Goss, {John A.} and Nicholas, {Sarah K.}",

note = "Funding Information: Disease. KRM was supported by a grant from the National Institutes of Health (T 32DK007664). Funding Information: Funding information Cade R Alpard Foundation for Pediatric Liver Disease. KRM was supported by a grant from the National Institutes of Health (T 32DK007664). Publisher Copyright: {\textcopyright} 2018 Wiley Periodicals, Inc.",

year = "2018",

month = nov,

doi = "10.1111/petr.13263",

language = "English (US)",

volume = "22",

journal = "Pediatric Transplantation",

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number = "7",

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T1 - ABO-incompatible deceased donor pediatric liver transplantation

T2 - Novel titer-based management protocol and outcomes

AU - Mysore, Krupa R.

AU - Himes, Ryan W.

AU - Rana, Abbas

AU - Teruya, Jun

AU - Desai, Moreshwar S.

AU - Srivaths, Poyyapakkam R.

AU - Zaruca, Kimberly

AU - Calvert, Andrea

AU - Guffey, Danielle

AU - Minard, Charles G.

AU - Morita, Eda

AU - Hensch, Lisa

AU - Losos, Michael

AU - Kostousov, Vadim

AU - Hui, Shiu Ki Rocky

AU - Orange, Jordan S.

AU - Goss, John A.

AU - Nicholas, Sarah K.

N1 - Funding Information: Disease. KRM was supported by a grant from the National Institutes of Health (T 32DK007664). Funding Information: Funding information Cade R Alpard Foundation for Pediatric Liver Disease. KRM was supported by a grant from the National Institutes of Health (T 32DK007664). Publisher Copyright: © 2018 Wiley Periodicals, Inc.

PY - 2018/11

Y1 - 2018/11

N2 - ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.

AB - ABO-ILT have re-emerged as an alternate option for select patients awaiting transplant. However, treatment protocols for children undergoing deceased donor ABO-ILT are not standardized. We implemented a novel IS protocol for children undergoing deceased donor ABO-ILT based on pretransplant IH titers. Children with high pretransplant IH titers (≥1:32) underwent an enhanced IS protocol including plasmapheresis, rituximab, IVIG, and mycophenolate, while children with IH titers ≤1:16 received steroids and tacrolimus. We retrospectively assessed our outcomes of ABO-ILT with ABO-compatible recipients of similar age and diagnosis over a 2-year period. Ten children with median age of 8.9 months underwent ABO-ILT, 4 of 10 patients underwent enhanced IS due to high IH titers. Rates of complications (rejection, infections, biliary, and vascular) at both 1 year and up to 3 years post-transplant were comparable between the groups. Patients with ABO-ILT had good graft function with 100% survival at a median follow-up of 3.3 years. In conclusion, IS tailored to pretransplant IH titers in pediatric deceased donor ABO-ILT is feasible and can achieve outcomes similar to ABO-CLT at 1 and 3 years post-transplantation.

KW - ABO incompatible

KW - deceased donor

KW - immunosuppression

KW - isohemagglutinin

KW - liver transplant

KW - pediatric

KW - plasmapheresis

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JO - Pediatric Transplantation

JF - Pediatric Transplantation

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ER -

ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes

Abstract

Keywords

ASJC Scopus subject areas

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