title: Pediatric Liver Transplantation Across the ABO Blood Group Barrier: Is It an Obstacle in the Modern Era?
abstract: BACKGROUND
  The initial experience with ABO incompatible (ABOi) orthotopic liver transplantations (OLTs) was dismal. In the current study, we investigated whether ABOi pediatric OLTs could achieve acceptable patient outcomes. The option for ABOi transplantation is vital because critically ill children have limited access to donor liver allografts.
  
  
  METHODS
  Kaplan-Meier and multivariate Cox analysis was performed on data collected from 13,179 pediatric OLT recipients in the United Network for Organ Sharing database, including 540 ABOi recipients. We also analyzed 18 pediatric recipients of ABOi OLTs at Texas Children's Hospital. Recipients were divided into 2 groups: transplanted between 1987 to 2002 (remote era) and 2002 to 2013 (modern era).
  
  
  RESULTS
  Analysis revealed 4 main points. First, there was a significant (p < 0.01) improvement in ABOi OLT survival in the modern era. Second, threshold analysis revealed superior outcomes (p < 0.01) for OLT recipients younger than 2 years of age. Third, survival outcomes for ABOi and ABO-identical OLTs were the same for recipients younger than 2 years: ABOi was 91.8% (1 year) and 88.4% (5 year), and ABO identical was 91.5% (1 year) and 86.7% (5 year) (p = 0.94). Lastly, we found identical OLT results when analyzing our own institutional experience. To date, there has been a 92.9% survival rate in the modern era compared with 75% in the remote era. All recipients younger than 2 years (n = 9) are still alive, compared with 78% of those older than 2 years.
  
  
  CONCLUSIONS
  This analysis revealed a significant improvement in the survival of ABOi liver transplant recipients in the modern era. Importantly, ABOi liver transplantation can be performed in recipients younger than 2 years of age with equivalent outcomes compared with ABO-identical recipients.
authors.affiliation: Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX. Electronic address: abbas.rana@bcm.edu.
authors.forename: Abbas
authors.initials: A
authors.lastname: Rana
authors.affiliation: Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kueht
authors.affiliation: Division of Immunology, Allergy and Rheumatology, Department of Pediatric Medicine, Texas Children's Hospital, Houston, TX.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Nicholas
authors.affiliation: Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Jindra
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, Texas Children's Hospital, Houston, TX.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Himes
authors.affiliation: Division of Intensive Care, Department of Pediatric Medicine, Texas Children's Hospital, Houston, TX.
authors.forename: Moreshwar S
authors.initials: MS
authors.lastname: Desai
authors.affiliation: Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Cotton
authors.affiliation: Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: N Thao N
authors.initials: NT
authors.lastname: Galvan
authors.affiliation: Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: Christine A
authors.initials: CA
authors.lastname: O'Mahony
authors.affiliation: Michael E DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, Houston, TX; Department of Surgery, Texas Children's Hospital, Houston, TX.
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
mesh_terms: D000017:ABO Blood-Group System; D000367:Age Factors; D001787:Blood Group Incompatibility; D002648:Child; D002675:Child, Preschool; D058625:End Stage Liver Disease / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System