ABO-incompatible living-donor lobar lung transplantation

The first successful case of ABO-incompatible living-donor lobar lung transplantation following desensitization therapy

ABO-incompatible (ABO-I) living-donor lobar lung transplantation (LDLLT) was successfully performed in a 14-year-old girl who suffered from bronchiolitis obliterans due to graft-versus-host disease following hematopoietic stem cell transplantation. In the ABO-I LDLLT procedure, the blood type O patient received a right lower lobe donated from her blood type B father and a left lower lobe donated from her blood type O mother. Desensitization therapy, using rituximab, immunosuppressants, and plasmapheresis, was implemented for 3 weeks prior to transplantation to reduce the production of anti-B antibodies in the recipient and prevent acute antibody-mediated rejection after ABO-I LDLLT.

Expanding Donor Options for Lung Transplant: Extended Criteria, Donation After Circulatory Death, ABO Incompatibility, and Evolution of Ex Vivo Lung Perfusion

Only using brain-dead donors with standard criteria, the existing donor shortage has never improved in lung transplantation. Currently, clinical efforts have sought the means to use cohorts of untapped donors, such as extended criteria donors, donation after circulatory death, and donors that are ABO blood group incompatible, and establish the evidence for their potential contribution to the lung transplant needs. Also, technical maturation for using those lungs may eliminate immediate concerns about the early posttransplant course, such as primary graft dysfunction or hyperacute rejection. In addition, recent clinical and preclinical advances in ex vivo lung perfusion techniques have allowed the safer use of lungs from high-risk donors and graft modification to match grafts to recipients and may improve posttransplant outcomes. This review summarizes recent trends and accomplishments and future applications for expanding the donor pool in lung transplantation.

Implications of blood group on lung transplantation rates: A propensity-matched registry analysis

BACKGROUND

Blood type O lung allografts may be allocated to blood type identical (type O) or compatible (non-O) candidates. We tested the hypothesis that the current organ allocation schema in the United States-based on the Lung Allocation Score-prejudices against the allocation of allografts to type O candidates, given that the pool of potential donors is smaller.

METHODS

We performed a retrospective cohort review of the Organ Procurement and Transplantation Network/United Network of Organ Sharing registry from May 2005 to March 2017 for adult candidates on the waiting list for first-time isolated lung transplantation. Demographic data were compiled and described, and 1:1 nearest-neighbor propensity score matching was used to adjust for age and Lung Allocation Score at listing.

RESULTS

A total of 26,396 candidates met inclusion criteria: 14,329 type non-O and candidates and 12,068 type O candidates. After matching, 11,951 candidates were included in each group. Of these, 77.0% of type non-O underwent lung transplantation vs 73.1% type O (p < 0.001). At 1 year, the waiting list mortality was higher for type O candidates (12.5%) than for non-O candidates (10.1%, p < 0.001). Of those undergoing transplantation, 5-year survival rates were similar.

CONCLUSIONS

Type O candidates experience lower rates of transplantation and higher rates of waiting list mortality compared with matched type non-O candidates. Further evaluation of regional sharing of allografts to increase transplantation rates for type O candidates may be warranted to optimize equity in access to transplants.

Current State of Pediatric Lung Transplantation

Cardiothoracic transplantation has significantly impacted the lives of pediatric patients with advanced cardiopulmonary failure. The current state of lung transplantation in children as well as its ongoing and future challenges are discussed.

Incidence and pattern of hemolytic anemia after minor ABO-mismatched living-donor lobar lung transplantation

PURPOSE

Living-donor lobar lung transplantation (LDLLT) has been successfully performed in Japan. In LDLLT, the recipient usually receives one lower lobe from each of two donors; however, finding two ABO-matched donors is often difficult. Solid organ transplants from donors with minor ABO-mismatches can be complicated by hemolysis. We investigated the incidence of de novo anti-ABO antibody production and hemolysis in patients receiving LDLLT across minor ABO-mismatches.

METHODS

We evaluated 23 patients who underwent LDLLT between June 2008 and December 2011, including 11 patients who underwent minor ABO-mismatched transplantation. We measured the anti-A/B antibody serum titers, hemoglobin concentrations and indirect bilirubin levels.

RESULTS

None of the patients showed any clinical signs of hemolytic anemia (mean follow-up period; 16 months). Two of the 11 patients (18 %) receiving minor ABO-mismatched LDLLTs showed a small amount of de novo anti-B antibodies for a transient period. These patients showed gradual progression of anemia, and weak de novo anti-A/B antibodies were detected with column agglutination technology. The patients received only 2 U of washed type O red blood cells; thereafter, the hemolytic anemia did not develop further in either case.

CONCLUSION

LDLLT across minor ABO-mismatches results in the transient appearance of weak de novo anti-A/B antibodies with a low incidence; thus, this procedure can be a safe treatment.