Liver Transplantation Using Abo-Incompatible Donors; A Single Center Experience Of 23 Adult Recipients

Background: The use of deceased ABO-incompatible (ABOi) donors in liver transplantation (Lt) is controversial and available data on the topic is sparse, especially regarding adult ABOi Lt. In a retrospective study we analyzed the outcome 23 adult ABOi Lts. Patients and methods: From 1997 to 2010, 23 ABOi Lts were performed. Eleven women and 22 men, median age of 51 years (range 13-73). In 18 patients acute liver failure (ALF) was the reason for ABOi Lt, MELD 38 (range 14-40). Five received an ABOi graft because of HCC or long waiting time. In 5 of 23 ABOi Lt represented a repeat transplantation. Median donor age was 50 years (range 10-86). Distribution of ABO-types were: A1→O n=7, A2→O n=8, B→O n=5, A1→B n=2 and AB→A n=1. They received standard triple immunosuppression with steroids, tacrolimus and mycophenolate mofetil. Eighteen of 23 received induction with IL-2 antagonist (5) or anti-CD20 antibody (13) or both (10). Nine were given immunoglobulins (0.5g/kg, day 0-4). One received plasmaferesis(PF) prior to transplantation. Median follow-up time was 22 months (range 10-164). Results: Two patients died of cardiac arrest during reperfusion. Three patients died with a functioning graft, 2 from sepsis and 1 from disseminated cancer. Total rate of vascular and biliary complications were 35% and 30%, respectively. Six patients (26%) were retransplanted due to rejection(2) or bile duct problems(4). 15 of 23 patients (65%) received anti-rejection therapy during the first month (12 BPAR) of 40% classified as steroid resistant rejections. Anti-A and B titers were measured regularly the first 4 weeks. Sixteen of 23 patients received PF (8 patients) or selective immunoadsorption columns (8 patients). Median IgMmax was 32 (range 1-1024), median IgGmax was 128 (range 2-4096). 1, 3 and 5 year Kaplan Meier estimate of patient (PS) and graft (GS) survival were 91/76%, 75/51% and 75/51% respectively, compared to 89/83%, 89/83% and 85/75% for 37 ABO-compatible transplantations due to ALF in the same period (PS p=0.37, GS p =0.05) Conclusion: ALF was the main indication for ABOi Lt in the study, and as such it was clearly justified. However, although modern available tools to prevent complications of ABOi Lt were utilized, GS was inferior compared to ABO-compatible Lt. Thus, it seems that ABOi Lt may be used in urgent situations without negative impact on patient survival, but should be avoided if possible.