Risk factors for liver transplantation across the ABO barrier.
A retrospective study was performed to identify risk factors affecting the fate of liver allografts transplanted across the ABO barrier. Over a 5-year period, 30 patients received 31 emergency OLTs with ABO-incompatible allografts. One-year graft and patient survival rates were 37.1% and 48.4%, respectively. This group was compared with 199 ABO-compatible OLTs performed under similar emergency conditions. Significantly higher incidence of rejection, hepatic artery thrombosis, and biliary stricture were found in ABO-incompatible grafts. The graft or patient survival of patients with O blood group or fulminant hepatic failure was not affected by ABO incompatibility. In contrast, the 1-year survival of recipients with non-O blood group was only 13.3% and the 1-year survival of those undergoing retransplantation was only 27.7% after ABO-incompatible OLT. A multivariate analysis using the Cox proportional hazard model identified non-O blood group (relative risk 3.43) and retransplantation (relative risk 2.46) as the most important risk factors for patient survival after ABO-incompatible OLT. We conclude that the use of ABO-incompatible grafts is justified in emergency cases when no other donor is available, but should be proscribed in patients with non-O blood group. The value of ABO-incompatible grafts in retransplantation is questionable and requires further investigation.
Lo
C M
CM
Department of Surgery, University of California at Los Angeles.
Shaked
A
A
Busuttil
R W
RW
D000017:ABO Blood-Group System; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001660:Biliary Tract Diseases / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000097:blood; D006085:Graft Survival / Q000276:immunology; D006499:Hepatic Artery; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013927:Thrombosis / Q000209:etiology
D000017:ABO Blood-Group System