Current techniques for AB0-incompatible living donor liver transplantation.

Area of Science:

• Transplantation immunology
• Hepatology
• Immunosuppression strategies

Background:

• AB0-incompatible (AB0i) liver transplantation is increasingly performed due to organ shortages.
• Historically, neglecting blood group compatibility was considered malpractice.
• Early graft rejection and biliary complications remain challenges in AB0i LDLT.

Purpose of the Study:

• To review and compare treatment strategies for AB0-incompatible living donor liver transplantation (AB0i LDLT).
• To evaluate the impact of various immunosuppression regimens and plasma treatment procedures on graft outcomes.
• To identify optimal approaches for improving graft survival and reducing complications in AB0i LDLT.

Main Methods:

• A comparative review of 11 transplant center regimens and their outcomes from 2010 to the present.
• Analysis of treatment protocols including immunosuppression, plasma treatment, and prophylactic rituximab.
• Evaluation of graft survival rates and complication profiles.

Main Results:

• Improvements in AB0i LDLT outcomes have been achieved through enhanced immunosuppression and plasma treatment.
• Prophylactic rituximab, administered over a week before AB0i LDLT, demonstrated the most significant improvement alongside plasma treatment.
• Despite variations in center-specific protocols, transplant results were consistently positive.

Conclusions:

• AB0-incompatible living donor liver transplantation (AB0i LDLT) is a viable option, particularly for emergency situations, with careful planning.
• Refined treatment strategies, including prophylactic rituximab, have made AB0i LDLT nearly free of severe complications.
• Standardized protocols are lacking, yet outcomes remain homogeneous across centers, highlighting the efficacy of current approaches.