Liver transplantation with deceased ABO-incompatible donors is life-saving but associated with increased risk of rejection and post-transplant complications.
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.
Section for Transplant Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
Trygve
T
Thorsen
Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden.
Ulrika S
US
Dahlgren
Section for Transplant Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.|Biotechnology Centre of Oslo, University of Oslo, Oslo, Norway.|Centre for Molecular Medicine Norway, Nordic EMBL Partnership, University of Oslo, Oslo, Norway.
Einar Martin
EM
Aandahl
Department of Pathology, Oslo University Hospital, Oslo, Norway.
Krzysztof
K
Grzyb
Section for Gastroenterology, Department of Transplantation Medicine, Norwegian PSC Research Centre, Oslo University Hospital, Oslo, Norway.|Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Tom H
TH
Karlsen
Section for Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
Kirsten M
KM
Boberg
Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.
Lennart
L
Rydberg
Oslo University Hospital, Institute of Immunology, Oslo, Norway.
Christian
C
Naper
Section for Transplant Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Aksel
A
Foss
Transplant Institute, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg, Sweden.
William
W
Bennet
D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001787:Blood Group Incompatibility; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival / Q000276:immunology; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
D000017:ABO Blood-Group System
ABO; deceased; donor; incompatible; liver; subgroup A2; transplantation