title: ABO-incompatible liver transplantation in acute and acute-on-chronic liver failure.
abstract: OBJECTIVE
  ABO-incompatible (ABO-I) liver transplantation (LTx) may be mandatory in urgent conditions such as acute liver failure (ALF) or acute-on-chronic liver failure (ACLF) when deceased donor (DD) is unavailable or living donor (LD) selection is limited. This study specifically addresses the problem of urgent ABO-I LTx in critically ill adult patients having ALF or severely decompensated end-stage liver disease.
  
  
  METHODS
  This series included 16 patients, 10 underwent ABO-I LD LTx and 6 underwent 7 ABO-I DD LTx. Multiple sessions of plasmapheresis reduced isoaglutinin titres to 1/16 or below, before and after LTx.
  
  
  RESULTS
  Mean follow-up period was 10.37 months (1 to 38). Median for MELD scores was 22.5 (17 to 30). Median survival was 9 months and mean survival was 19.5 months. Hospital mortality was 3 (18.7%). Two patients died due to small for size graft syndrome and cerebrovascular bleeding respectively. Hepatic artery thrombosis developed in 3 patients. Two of them died at postoperative 4th and 9th months. Third patient is still alive with hepatic necrosis problem.
  
  
  CONCLUSIONS
  ABO-I LTx remains an important and unavoidable therapeutic option in adult patients with ALF or ACLF and urgent need for an allograft without the possibility to allocate a blood group compatible liver graft.
authors.forename: Sezai
authors.initials: S
authors.lastname: Yilmaz
authors.forename: Cemalettin
authors.initials: C
authors.lastname: Aydin
authors.forename: Burak
authors.initials: B
authors.lastname: Isik
authors.forename: Cuneyt
authors.initials: C
authors.lastname: Kayaalp
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Cengiz
authors.initials: C
authors.lastname: Ara
authors.forename: Ramazan
authors.initials: R
authors.lastname: Kutlu
authors.forename: Yasar
authors.initials: Y
authors.lastname: Bayindir
authors.forename: Veysel
authors.initials: V
authors.lastname: Ersan
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology*; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System