Comparable long-term survival and biliary outcomes in ABO-incompatible and compatible living donor liver...

ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) has demonstrated acceptable short-term outcomes with rituximab-based desensitization. However, data on long-term outcomes remain limited. This study aimed to evaluate the long-term impact of ABO incompatibility on LDLT outcomes, particularly patient survival and biliary complications.

A retrospective review was conducted of patients undergoing LDLT at a single center between January 2012 and December 2022. Patients were categorized into ABO-I and ABO-compatible (ABO-C) groups. Long-term outcomes, including overall survival and biliary complications, were compared.

A total of 511 patients underwent LDLT, comprising 121 ABO-I and 390 ABO-C recipients. Recipient baseline characteristics were comparable between groups, while donor age, sex, and biological relationship differed significantly. The median follow-up duration was 90.1 months. The 3-, 5-, and 10-year overall survival rates were 73.9%, 65.3%, and 61.4% in the ABO-I group, and 77.5%, 73.7%, and 69.6% in the ABO-C group (p = 0.1147). Cumulative biliary complication rates at 3, 5, and 10 years were 48.3%, 51.9%, and 53.4% in the ABO-I group, compared to 46.0%, 49.2%, and 50.9% in the ABO-C group (p = 0.9243). Risk factor analysis identified prolonged operative time as a predictor of biliary complications in ABO-I recipients and prolonged hospital stay in ABO-C recipients.

ABO-I LDLT provides comparable long-term outcomes to ABO-C LDLT in terms of overall survival and biliary complications under current desensitization and immunosuppressive protocols. ABO-I LDLT is a safe and effective option when ABO-compatible donors are unavailable.