DOUBLE VOLUME EXCHANGE-TRANSFUSION FOR ABO-INCOMPATIBLE LIVER-TRANSPLANTATION IN PEDIATRIC-PATIENTS - INTRAOPERATIVE AND PREOPERATIVE APPROACH

Double volume blood exchange transfusions (DBVET) were used to reduce the serum antibody levels in six paediatric patients receiving ABO inc ompatible hepatic allografts. In four patients, the exchange transfusi ons took place on the ward prior to surgery. In three of these four pa tients who had titres measured, the anti-A IgM titres fell from 1024 t o 64, 64 to 8, and 128 to 16, respectively. The anti-A IgG titres fell from 32 to 16 and 512 to 64 in two patients, but rose from 16 to 32 i n the third. In two patients DBVET were performed intraoperatively usi ng a rapid infusion device. The IgM titres fell from 256 to 32 and 64 to 1, respectively, and the IgG titres fell from 16 to 4 and 2 to 0. I ntraoperative DBVET can acutely and effectively reduce blood group ant ibodies. Intraoperative DBVET may reduce graft ischaemia time and allo w red blood cell salvage.