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Case‐matched comparison of ABO‐incompatible and ABO‐compatible living donor liver transplantation. BJS 2016; 103: 276-283.

Published: 23rd December 2015

Authors: J. M. Kim, C. H. D. Kwon, J.‐W. Joh, S. B. Han, D. H. Sinn, G.‐S. Choi et al.

Background

ABO‐incompatible (ABO‐I) living donor liver transplantation (LDLT) has a high success rate. There are few detailed comparisons regarding biliary complications, infective complications and patient survival between ABO‐compatible (ABO‐C) and ABO‐I LDLT. The aim was to compare the outcomes of ABO‐I LDLT with those of ABO‐C LDLT using the matched‐pairs method.

Method

Patients who underwent ABO‐I LDLT procedures between 2010 and 2013 were studied. They were matched for significant variables with patients who had ABO‐C LDLT (1 : 2 matching).

Results

Forty‐seven ABO‐I LDLT procedures were included. Ninety‐four patients who had ABO‐C LDLT were selected as a comparator group. The incidence of cytomegalovirus, bacterial and fungal infections during the first 3 months was similar after ABO‐I LDLT and ABO‐C LDLT (85 versus 76 per cent, 28 versus 37 per cent, and 13 versus 20 per cent, respectively). Antibody‐mediated rejection occurred after two procedures within 2 weeks of transplantation, but liver function improved with plasma exchange in both patients. There were no differences in the rate of acute rejection and biliary complications between ABO‐I and ABO‐C groups (P = 0·478 and P = 0·511 respectively). Three patients who had ABO‐I LDLT developed diffuse intrahepatic biliary complications and progressed to graft failure. The 1‐, 2‐ and 3‐year patient survival rates after ABO‐I LDLT and ABO‐C LDLT were 89 versus 87 per cent, 85 versus 83 per cent, and 85 versus 79 per cent, respectively.

Conclusion

The short‐term outcomes of ABO‐I LDLT were comparable to those of ABO‐C LDLT in this study. ABO‐I LDLT is an effective and safe transplant option with the potential to expand the pool of live donors.

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