Current progress in ABO-incompatible liver transplantation.
BACKGROUND
ABO-incompatible (ABOi) living donor liver transplantation (LDLT) in adult patients has been controversial because of the high risk of antibody-mediated rejection (AMR) mediated by preformed anti-ABO antibodies. However, outcomes have recently improved owing to various treatment advances.


METHODS
This review article describes the history and current progress in ABOi liver transplantation, mainly from the viewpoint of the Japanese experience.


RESULTS
The typical clinical manifestations of AMR are hepatic necrosis and intrahepatic biliary complication. The outcomes of early ABOi LDLT were poor, especially in older children and adult cases. Since we first introduced portal vein infusion therapy into adult ABOi LDLT in 1998, local graft infusion therapy has emerged in Japan as a crucial breakthrough to overcome the ABO blood group barrier. From 2003, rituximab prophylaxis has been widely used with local graft infusion, and has resulted in markedly improved patient survival. The novel approach of intravenous immunoglobulin induction may become another option to suppress AMR. Continued patient enrollment and controlled trials will allow further validation of these treatments.


CONCLUSIONS
The outcome of ABOi LDLT is now similar to that of blood-type-matched transplantation in Japan. However, infection is the major cause of morbidity and mortality after ABOi LDLT. Thus, evaluation of the patients' immune status and adjustment of immunosuppression will be the way forward in the future.
Tanabe
Minoru
M
Department of Surgery, Keio University School of Medicine, Tokyo, Japan. m-tanabe@sc.itc.keio.ac.jp
Kawachi
Shigeyuki
S
Obara
Hideaki
H
Shinoda
Masahiro
M
Hibi
Taizo
T
Kitagawa
Yuko
Y
Wakabayashi
Go
G
Shimazu
Motohide
M
Kitajima
Masaki
M
D000017:ABO Blood-Group System / Q000276:immunology*; D000906:Antibodies / Q000276:immunology*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D001787:Blood Group Incompatibility / Q000276:immunology*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use; D016031:Liver Transplantation / Q000276:immunology* / Q000379:methods; D019520:Living Donors; D011169:Portal Vein; D000069283:Rituximab; D013156:Splenectomy
D000017:ABO Blood-Group System; D000906:Antibodies; D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D000069283:Rituximab