ABO Incompatible Adult Living Donor Liver Transplantation: 7-Year Experiences of 340 Cases at Single Institute

Introduction: ABO-incompatible (ABOi) adult living donor liver transplantation (ALDLT) has been establisged as an optimal teatment of end-stage liver disease if ABO compatible (ABOc) donor does not exist. Here, we report the largest single center experience of ABO-incompatible (ABOi) ALDLT in 340 patients during 7 years. Method: The desensitization (DSZ) protocol included a single dose of rituximab and total plasma exchange. Additionally, local graft infusion therapy, cyclophosphamide, or splenectomy was used for a certain time period, but this was eventually discontinued due to adverse events. Results: Total 340 cases of ABOi ALDLT were performed from November 2008 to October 2015. It accounts for 15.9% of all ADLLTs which were performed during same period. The mean age and MELD score of patients was 52.0±8.0 and 13.1±9.0, respectively. There were 4 cases (1.2%) of in-hospital mortality. The cumulative 3-year graft and patient survival rates were 88.9% and 93.3%, respectively, which were comparable to those in the ABOc group (n = 2,136, p = 0.324). There was no significant diffrences of survival outcomes in propensity-matched cohort (p = 0.631) Despite promising survival outcomes, howewver, 23 (6.7%) patients experienced antibody-mediated rejection that manifested by diffuse intrahepatic biliary stricture, with six cases requiring re-transplantation and three deaths. There was no significant statistical difference in the incidence of acute cellular rejection and surgical complication bewteen ABOi and ABOc groups. Conclusion: ABOi ALDLT is a feasible method for expanding a live liver donor pool, but the efficacy of the DSZ protocol in targeting B-cell immunity should be optimized.