ABO-incompatible living donor intestinal transplantation: report of one case

Objective To summarize the therapeutic experience of one case of an ABO incompatible living-related intestinal transplantation with an 18-month follow-up.Method A 16-yearold girl was referred with suspected bowel infarction secondary to superior mesenteric thrombosis.Exploratory laparotomy revealed an extensive bowel necrosis,requiring removal of the third and fourth part of the duodenum,the entire small bowel and the ascending and the proximal transverse colon.The duodenum was closed just distal to the ampulla of Vater and a gastrostomy tube was placed for drainage.After discussion with her family,we decided to undertake a living-related intestinal transplantation.Lab tests indicated her B blood-type but absence of ABO identical or compatible donors in her family.During a long waiting period for a cadaveric donor,she developed several episodes of recurrent aspiration and the lung cavitation.Her 48-year-old father with an AB blood-type was considered as donor.Induction therapy included Rituximab,antithymocyte globulin(ATG) and plasma exchange.The donor's distal 180 cm ileum was transplanted.Result The recipient's postoperative course was remarkable for one episode of mild acute rejection on postoperative day 15,which was successfully treated with steroid bolus and ATG.Due to delayed gastric empty,a clear liquid diet was started on day 45 and she well tolerated a soft diet by day 60 and then was completely off total parenteral nutrition.During an 12-month follow-up period,she gained 4 kg.The donor spent 6 days in hospital and has done well since discharge.Conclusion Our preliminary experience suggests that ABO incompatible living donor bowel transplantation can be lifesaving when ABO identical or compatible donor is unavailable. Key words: ABO blood-group system;  Blood group incompatibility;  Short bowel syndrome; Intestinal transplantation;  Living donors