Background: ABO incompatible liver transplantation is still controversial, but
accepted in selected cases. Recently several authors reported the use of new
technology helping to eliminate and reduce post-transplant anti-donor ABO
specific hemagglutinin titters to assist immunosuppression in preventing acute rejection after transplantation. We report the case of a liver transplantation with ABO incompatible graft under immunoadsorption protocol.
Case Report: 17 year-old boy with acute decompensation of chronic liver failure due to PSC and AIH was qualified for urgent liver transplantation. After 3 following ABO incompatible donors we decided to perform liver transplantation across blood groups (donor: B, Rh positive; recipient A, Rh positive). Immunosuppressive protocol consisted of basiliximab, tacrolimus, mycophenolate mofetil and corticosteroids. Additionally 3 immunoadsorption sessions with ABO Glycorex type B on 3, 7, 12 postoperative days were performed. Anti-B isoagglutinin titter was 1:2048. Just after transplantation it dropped to 1:4 and increased again to 1:1024 on postoperative day 6 and then to 1:8192 on post operative day 10. After 3rd immunoadsorption the titter decreased to 1:64 on day 21. There was no acute rejection until he was discharged home and until now, 6 months after Tx. The liver function is excellent. The only problem observed after transplantation was mild anaemia due to the low grade haemolysis in the postoperative period.
Conclusions: Immunoadsorption therapy has been safely and effectively introduced in a patient with ABO incompatible donor liver transplantation.

Keywords: Liver Transplantation