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Liver transplantation with deceased ABO-incompatible donors is life-saving but associated with increased risk of rejection and post-transplant complications.

Journal article
Authors Trygve Thorsen
Ulrika Skogsberg Dahlgren
Einar Martin Aandahl
Krzysztof Grzyb
Tom H Karlsen
Kirsten M Boberg
Lennart Rydberg
Christian Naper
Aksel Foss
William Bennet
Published in Transplant international : official journal of the European Society for Organ Transplantation
Volume 28
Issue 7
Pages 800-12
ISSN 1432-2277
Publication year 2015
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Biomedicine, Department of Clinical Chemistry and Transfusion Medicine
Pages 800-12
Language en
Keywords ABO Blood-Group System, immunology, Adolescent, Adult, Aged, Aged, 80 and over, Blood Group Incompatibility, Child, Female, Follow-Up Studies, Graft Rejection, immunology, Graft Survival, immunology, Humans, Liver Failure, surgery, Liver Transplantation, Male, Middle Aged, Postoperative Complications, immunology, Retrospective Studies, Risk Factors, Treatment Outcome, Young Adult
Subject categories Immunology in the medical area, Gastroenterology and Hepatology, Transplantation surgery


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.

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