ABSTRACT
ABO incompatible organ transplantation has been contraindicated because of acute rejection or hyperactive rejection by its antigen-antibody reaction. To overcome these problems, plasma pheresis, antibody adsorption and other diverse methods have been tried by many investigators. The authors experienced a case of orthotopic liver transplantation across the ABO incompatibility by using plasma pheresis. The recipient was a 3-year-old male with blood type B, and the donor was his father with blood type AB. Perioperative plasma pheresis was performed a total of four times. The initial anti-A titer was 1:64; after the plasma pheresis, the titer was weakened to 1:4. Orthotopic liver allografting was successfully accomplished without hyperacute rejection. The usual mild acute rejection symptom was noted, but no serious problem developed. As in this experience, an ABO incompatible liver transplant is not an absolute, but a relative, contraindication. Selecting the proper candidate and using plasma pheresis should be a good optional approach for ABO incompatible transplantation patients.