Compatible ABO mismatch and liver transplantation: a single center's experience

Area of Science:

• Transplantation Medicine
• Immunology
• Hepatology

Background:

• Organ donor shortages necessitate the use of ABO-mismatched grafts in liver transplantation.
• Previous studies indicated significantly lower graft survival rates for ABO-mismatched compared to ABO-identical or ABO-compatible grafts.

Purpose of the Study:

• To compare patient and graft survival rates between ABO-identical and ABO-compatible mismatched liver transplant recipients.
• To evaluate the safety and efficacy of ABO-compatible mismatched liver transplantation in urgent cases.

Main Methods:

• Retrospective review of 520 orthotopic liver transplantations (OLTx) performed between November 1992 and May 2003.
• Analysis of patient and graft survival data for 55 ABO-compatible mismatched transplants compared to ABO-identical transplants.

Main Results:

• No statistically significant differences were observed in 1-month, 1-, 5-, or 10-year patient survival rates between ABO-identical and ABO-compatible mismatched groups (P>.05).
• Similarly, graft survival rates at 1-month, 1-, 5-, and 10-years showed no significant differences between the two groups (P>.05).
• Patients in the mismatched group generally had high United Network for Organ Sharing (UNOS) status; one incompatible (B to A) graft resulted in primary nonfunction.

Conclusions:

• ABO-compatible mismatched liver transplantation is an unavoidable procedure given current organ scarcity.
• This approach can be performed with acceptable risk, particularly for patients with urgent transplantation needs and high UNOS/MELD scores.