Successful ABO-incompatible liver transplantation using A2 donors.

Area of Science:

• Transplantation immunology
• Hepatology
• Surgical innovation

Background:

• Blood group O patients face longer liver graft waiting times.
• Expanding the donor pool for blood group O recipients is crucial.
• ABO-incompatible liver transplantation (ABOiLT) is an option.

Purpose of the Study:

• To report outcomes of ABOiLT using A(2) donors for blood group O recipients.
• To evaluate the safety and efficacy of this specific donor-recipient blood group combination.
• To assess patient and graft survival, and rejection rates.

Main Methods:

• 10 adult blood group O recipients received A(2) cadaveric liver grafts (1996-2005).
• Immunosuppression included induction therapy (antithymocyte globulin, IL-2 receptor antagonists, or rituximab) followed by tacrolimus.
• No pre-transplant plasmapheresis, immunoadsorption, or splenectomy was performed.

Main Results:

• Patient survival was 10/10 and graft survival was 8/10 at a median follow-up of 8.5 months.
• Six acute rejections in four patients were successfully reversed with steroids or increased tacrolimus.
• Two patients required retransplantation due to bacterial arteritis and portal vein thrombosis.

Conclusions:

• A(2) to O liver grafting demonstrates favorable outcomes, suitable for non-urgent cases.
• No hyperacute rejection or increased rate of rejection was observed.
• Anti-A/B titer changes may not be a significant monitoring factor in A(2) to O liver transplantation.