Acceptance of an ABO-incompatible mismatched (AB(+) to O(+)) liver allograft with the use of daclizumab and mycophenolate mofetil
Authors
Fang, W. ChristopherSaltzman, John R.
Rososhansky, Sarah
Szabo, Gyongyi
Heard, Stephen O.
Banner, Barbara F.
Chari, Ravi
Katz, Eliezer
UMass Chan Affiliations
Department of AnesthesiologyDepartment of Medicine, Division of Gastroenterology
Department of Surgery
Document Type
Journal ArticlePublication Date
2000-07-29Keywords
Antibodies, MonoclonalBlood 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
Metadata
Show full item recordAbstract
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 siteDOI
10.1053/jlts.2000.6448Permanent Link to this Item
http://hdl.handle.net/20.500.14038/38502PubMed ID
10915175Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1053/jlts.2000.6448