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    Acceptance of an ABO-incompatible mismatched (AB(+) to O(+)) liver allograft with the use of daclizumab and mycophenolate mofetil

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    Authors
    Fang, W. Christopher
    Saltzman, John R.
    Rososhansky, Sarah
    Szabo, Gyongyi
    Heard, Stephen O.
    Banner, Barbara F.
    Chari, Ravi
    Katz, Eliezer
    UMass Chan Affiliations
    Department of Anesthesiology
    Department of Medicine, Division of Gastroenterology
    Department of Surgery
    Document Type
    Journal Article
    Publication Date
    2000-07-29
    Keywords
    Antibodies, Monoclonal
    Blood Group Incompatibility
    Female
    Follow-Up Studies
    *Graft Survival
    Humans
    Immunoglobulin G
    Immunosuppressive Agents
    Liver Transplantation
    Middle Aged
    Mycophenolic Acid
    Plasmapheresis
    Postoperative Care
    Anesthesiology
    Gastroenterology
    Life Sciences
    Medicine and Health Sciences
    Surgery
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    Link to Full Text
    http://dx.doi.org/10.1053/jlts.2000.6448
    Abstract
    Liver allograft survival rates of 50% to 60% are reported in blood group A, group B, group O (ABO)-incompatible mismatched grafts even when aggressive immunosuppressive protocols, including plasmapheresis, OKT(3), cyclophosphamide, cyclosporine, prostaglandin E(1), and steroids, are used. A 59-year-old woman, blood type O(+), required emergency retransplantation posttransplantation day 2 because of primary nonfunction of the liver allograft. A blood type AB(+) allograft was used. Induction immunosuppressive therapy included tacrolimus, mycophenolate mofetil, OKT(3) (muromonab-CD(3)), steroids, and prostaglandin E(1). In addition, plasmapheresis was performed daily for 9 days. OKT(3) and prostaglandin E(1) were also discontinued postoperative day 9. Biopsy-proven acute cellular rejection was diagnosed postoperative day 12 and was treated with double-dose OKT(3) (10 mg) for another 6 days. On the day OKT(3) was discontinued, daclizumab, 60 mg, was administered intravenously. This dose was repeated every 2 weeks for a total of 5 doses. At 1-year follow-up, the patient is doing very well with normal liver function. We are unaware of previous reports of the use of daclizumab and mycophenolate mofetil as part of an immunosuppressive protocol aimed to induce acceptance of ABO-incompatible mismatched liver allografts. Based on our experience with this case, it seems that mycophenolate mofetil is an adequate replacement for cyclophosphamide. We also believe daclizumab provided adequate protection at a critical time. Further experience with both these drugs is required to establish their role in ABO-incompatible mismatched liver allografts.
    Source
    Liver Transpl. 2000 Jul;6(4):497-500. Link to article on publisher's site
    DOI
    10.1053/jlts.2000.6448
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/38502
    PubMed ID
    10915175
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1053/jlts.2000.6448
    Scopus Count
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