pISSN 2671-8790 eISSN 2671-8804


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Korean J Transplant 2020; 34(2): 109-113

Published online June 30, 2020


© The Korean Society for Transplantation

Successful ABO-incompatible living donor liver transplantation using splenectomy and intravenous immunoglobulin in high isoagglutinin titer patients

Boram Lee , Jai Young Cho , Hae Won Lee , YoungRok Choi , Yoo-Seok Yoon , Ho-Seong Han

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

Correspondence to: Jai Young Cho
Department of Surgery, Seoul National University Bundang Hospital, 82 Gumiro 173beon-gil, Bundang-gu, Seongnam 13620, Korea
Tel: +82-31-787-7098
Fax: +82-31-787-4078
E-mail: jychogs@gmail.com

Received: March 3, 2020; Revised: April 21, 2020; Accepted: April 22, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


The role of the isoagglutinin (IA) titer in liver transplantation (LT) is still not well defined, but the general belief is that a higher titer may result in a higher risk of rejection in ABO-incompatible living donor LT. To reduce the IA titer by 1:16 or lower, plasmapheresis is usually performed before transplantation. However, there is no established protocol for patients for whom plasmapheresis has failed before reaching the target IA titers. Here, we report the cases of three patients who show high baseline IA titers and have failed plasmapheresis: no-response to plasmapheresis, allergic reaction associated with plasmapheresis, and anaphylactic reaction to platelet transfusion. For various reasons, after several plasmapheresis procedures, IA titers were not effectively reduced. In these patients, splenectomy and intravenous immunoglobulin (0.8 g/kg, from the anhepatic phase to 2 days after transplantation) were carried. The protocol biopsy on postoperative day 7 showed no histologic evidence of meaningful acute rejection. The main aim of this work is to demonstrate that we can apply this protocol to patients who have high baseline IA titers and have failed plasmapheresis. Furthermore, this report is enhanced to promote to the transplant community this approach with this type of recipient.

Keywords: Liver transplantation, Plasmapheresis, Graft rejection, Splenectomy, Immunoglobulins, intravenous

  • Plasmapheresis is usually performed before transplantation.

  • Patients showed the high isoagglutinin titers even after plasmapheresis.

  • The splenectomy and intravenous immunoglobulin were applied.