Strategies for ABO Incompatible Liver Transplantation

Area of Science:

• Transplantation immunology
• Hepatology
• Surgical innovation

Background:

• Liver transplantation (LT) is crucial for end-stage liver disease.
• Limited cadaveric allografts necessitate expanded donor pools, including ABO incompatible (ABOi) living donors.
• Advancements in desensitization protocols have improved ABOi LDLT outcomes.

Purpose of the Study:

• To review current protocols and outcomes of ABO incompatible living donor liver transplantation (ABOi LDLT).
• To discuss the role of desensitization therapies in reducing antibody-mediated rejection.
• To explore emerging therapies and challenges in ABOi LT.

Main Methods:

• Review of desensitization protocols including Rituximab, plasmapheresis, and immunoadsorption.
• Analysis of post-transplant immunosuppression strategies.
• Discussion of newer agents like Belatacept and Obinutuzumab.

Main Results:

• Outcomes of ABOi LDLT are comparable to ABO compatible LT with current protocols.
• Rituximab combined with apheresis effectively reduces antibody titers and rejection risk.
• Higher tacrolimus levels are often targeted in ABOi LDLT post-transplant.

Conclusions:

• ABOi LDLT is a viable option to expand the donor pool, with outcomes matching ABO compatible LT.
• Standardized protocols and newer therapies are crucial for managing ABOi LT.
• Emergency ABOi LT presents unique challenges but shows encouraging preliminary results.