A CASE OF LIVING-DONOR LIVER TRANSPLANTATION FOR A PATIENT WITH HLA ANTIBODIES

Abstract

The presence of donor-specific HLA antibodies often causes humoral rejection in liver transplantation. When a direct cross-match test (DCT) on liver transplantation is positive, the result should be considered a particularly important clinical sign. We report a case of a female patient aged fifties with HLA antibody who was transplanted with an ABO-incompatible living-donor liver with positive DCT. Pretransplantation, she underwent immunosuppression using Rituximab and had three plasma exchanges to reduce anti B antibody titer because of the ABO-incompatible transplantation. PC-HLA-transfusions were effective in terms of thrombocytopenia on the operative day and after 4 weeks, but were refractory after 8 weeks when liver function was reduced. She later died of liver failure and sepsis. We had expected that strong immunosuppression would provide the patient with protection against strong rejection. Retrospective study showed that the platelet transfusion refractoriness (PTR) after 8 weeks was caused by thrombotic microangiopathy (TMA). This study demonstrated that prompt recognition and investigation concerning thrombocytopenia is important to allow the implementation of appropriate treatment.