PMID- 22407193
OWN - NLM
STAT- MEDLINE
DCOM- 20130919
LR  - 20160511
IS  - 1868-6982 (Electronic)
IS  - 1868-6974 (Linking)
VI  - 20
IP  - 3
DP  - 2013 Mar
TI  - Living donor liver transplantation for patients immunized against human leukocyte 
      antigen.
PG  - 279-85
LID - 10.1007/s00534-012-0511-0 [doi]
AB  - 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.
FAU - Shindoh, Junichi
AU  - Shindoh J
AD  - Division of Artificial Organ and Transplantation, Department of Surgery, 
      University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.
FAU - Sugawara, Yasuhiko
AU  - Sugawara Y
FAU - Tamura, Sumihito
AU  - Tamura S
FAU - Kaneko, Junichi
AU  - Kaneko J
FAU - Yamashiki, Noriyo
AU  - Yamashiki N
FAU - Aoki, Taku
AU  - Aoki T
FAU - Hasegawa, Kiyoshi
AU  - Hasegawa K
FAU - Sakamoto, Yoshihiro
AU  - Sakamoto Y
FAU - Kokudo, Norihiro
AU  - Kokudo N
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Japan
TA  - J Hepatobiliary Pancreat Sci
JT  - Journal of hepato-biliary-pancreatic sciences
JID - 101528587
RN  - 0 (Antigens, Human Platelet)
RN  - 0 (HLA Antigens)
RN  - 0 (Immunoglobulins, Intravenous)
SB  - IM
MH  - Adult
MH  - Antigens, Human Platelet/immunology
MH  - Enzyme-Linked Immunosorbent Assay
MH  - Fatal Outcome
MH  - Female
MH  - HLA Antigens/*immunology
MH  - Humans
MH  - Immunoglobulins, Intravenous/therapeutic use
MH  - Liver Transplantation/*immunology
MH  - *Living Donors
MH  - Male
MH  - Middle Aged
MH  - Platelet Transfusion
MH  - Postoperative Complications/immunology
MH  - Thrombotic Microangiopathies/immunology
MH  - Treatment Outcome
EDAT- 2012/03/13 06:00
MHDA- 2013/09/21 06:00
CRDT- 2012/03/13 06:00
PHST- 2012/03/13 06:00 [entrez]
PHST- 2012/03/13 06:00 [pubmed]
PHST- 2013/09/21 06:00 [medline]
AID - 10.1007/s00534-012-0511-0 [doi]
PST - ppublish
SO  - J Hepatobiliary Pancreat Sci. 2013 Mar;20(3):279-85. doi: 
      10.1007/s00534-012-0511-0.