ABO-incompatible liver transplantation and patients with hepatopulmonary syndrome

From 1991 to 2000, more than 100 ABO-incompatible liver transplantations were performed in 12 institution in Japan. The overall survival rate is 60%. Survival data appear to have improved in these years even in adult cases, although acute vascular rejection causing hepatic necrosis, infection, and intrahepatic bile duct injury are major complications to be resolved. Hepatopulmonary syndrome (HPS) was considered to be a contraindication to transplantation in the 1980s. However, even severe cases can recover from hypoxia after liver transplantation, and improved survival data were reported in the 1990s. Intensive respiratory therapy after transplantation with NO inhalation allows expansion of the indications for transplantation in HPS.