https://www.ncbi.nlm.nih.gov/pubmed/30341789 Liver transplant

Pediatr Transplant. 2018 Oct 19:e13308. doi: 10.1111/petr.13308. [Epub ahead of print]
ABO-incompatible liver transplantation for children under 2 years of age: A case report and a single-center review.
Narumoto S1, Sakamoto S1, Sasaki K1, Hirata Y1, Fukuda A1, Uchiyama T2, Irie R3, Yoshioka T3, Kasahara M1.

Abstract

Desensitization with RTX has been broadly introduced in adult LT across the ABO blood type barrier. For pediatric LT, the prophylactic use of RTX has not been standardized, especially for children under 2 years of age. A 20-month-old girl with BA underwent living donor LT from her ABO-I mother. On POD 6, she developed combined T cell-mediated and AMRs. Steroid bolus injection was immediately introduced, followed by antibody-depleting therapy with PE and IVIG. Based on a peripheral blood lymphocyte analysis by fluorescence-activated cell sorting, ATG and RTX were introduced for refractory rejection. Although she recovered from the combined rejections, IHBCs were inevitable as a consequence. We recommend extending the desensitization protocol to cover children under 2 years of age in order to prevent life-threatening complications.