Liver transplantation with deceased ABO‐incompatible donors is life‐saving but associated with increased risk of rejection and post‐transplant complications |
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| Authors: | Trygve Thorsen Ulrika S. Dahlgren Einar Martin Aandahl Krzysztof Grzyb Tom H. Karlsen Kirsten M. Boberg Lennart Rydberg Christian Naper Aksel Foss William Bennet |
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| Affiliation: | 1. Section for Transplant Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway;2. Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden;3. Biotechnology Centre of Oslo, University of Oslo, Oslo, Norway;4. Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo, Oslo, Norway;5. Department of Pathology, Oslo University Hospital, Oslo, Norway;6. Section for Gastroenterology, Department of Transplantation Medicine, Norwegian PSC Research Centre, Oslo University Hospital, Oslo, Norway;7. Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway;8. Institute of Clinical Medicine, University of Oslo, Oslo, Norway;9. Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden;10. Oslo University Hospital, Institute of Immunology, Oslo, Norway |
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| Abstract: | ABO‐incompatible (ABOi) liver transplantation (LT) with deceased donor organs is performed occasionally when no ABO‐compatible (ABOc) graft is available. From 1996 to 2011, 61 ABOi LTs were performed in Oslo and Gothenburg. Median patient age was 51 years (range 13–75); 33 patients were transplanted on urgent indications, 13 had malignancy‐related indications, and eight received ABOi grafts for urgent retransplantations. Median donor age was 55 years (range 10–86). Forty‐four patients received standard triple immunosuppression with steroids, tacrolimus, and mycophenolate mofetil, and forty‐four patients received induction with IL‐2 antagonist or anti‐CD20 antibody. Median follow‐up time was 29 months (range 0–200). The 1‐, 3‐, 5‐, and 10‐year Kaplan–Meier estimates of patient survival (PS) and graft survival (GS) were 85/71%, 79/57%, 75/55%, and 59/51%, respectively, compared to 90/87%, 84/79%, 79/73%, and 65/60% for all other LT recipients in the same period. The 1‐, 3‐, 5‐, and 10‐year GS for A2 grafts were 81%, 67%, 62%, and 57%, respectively. In conclusion, ABOi LT performed with non‐A2 grafts is associated with inferior graft survival and increased risk of rejection, vascular and biliary complications. ABOi LT with A2 grafts is associated with acceptable graft survival and can be used safely in urgent cases. |
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| Keywords: |
ABO
deceased donor incompatible liver subgroup A2 transplantation |
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