ABO Incompatible Grafts Are Associated With Excellent Outcomes in Pediatric Liver Transplant Recipients: An Important...

Area of Science:

• Pediatric Hepatology
• Transplant Surgery
• Immunology

Background:

• Liver transplant waitlist mortality affects 10% of children, necessitating innovative access strategies.
• Expanding access to liver transplantation is crucial for improving survival rates in pediatric patients.

Purpose of the Study:

• To compare outcomes of ABO incompatible (ABOi) liver transplants (LT) with ABO compatible (ABOc) LT in children.
• To evaluate the safety and efficacy of ABOi LT as a strategy to reduce waitlist times and mortality.

Main Methods:

• Retrospective analysis of ABOi LT (n=25) and ABOc LT (n=270) performed between 1999 and 2023.
• Comparison of patient and graft survival, complication rates (vascular, biliary), and rejection episodes.
• Analysis of waitlist times and recipient characteristics, including MELD/PELD scores and transplant status.

Main Results:

• ABOi recipients had significantly shorter waitlist times (11 days vs. 113 days, p<0.001).
• No significant differences in 1/5/10-year patient or graft survival between ABOi and ABOc LT.
• Similar rates of vascular complications and acute T-cell-mediated rejection; higher incidence of biliary strictures in ABOi LT (43% vs. 20%, p=0.0495).

Conclusions:

• ABO incompatible liver transplantation provides a survival benefit for pediatric patients by reducing waitlist duration.
• ABOi LT can be performed safely, demonstrating low vascular complication rates comparable to ABOc LT.
• While effective, ABOi LT requires careful management of biliary complications, particularly strictures.