Outcome of Emergent ABO-Incompatible Liver Transplantation is Acceptable but at the Cost of Higher Diffuse
Junfang Liu1,2, Jiameng Qi3, Ying Chen1,2
1Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Objective:
The efficacy and clinical outcomes of emergent rituximab-based desensitization therapy in ABO-incompatible liver transplantation (ABO-I LT) remain poorly characterized. In this study, we analyzed a single-center cohort of emergency ABO-I LT recipients to delineate key clinical features and identify independent predictors of post-transplant survival.
Methods:
Between January 1, 2015, and August 31, 2021, 1015 (90.2%) recipients received ABO-compatible (ABO-C) deceased donor liver transplantation (DDLT), and 110 (9.8%) received ABO-I DDLT with emergent rituximab-based desensitization.
Results:
The ABO-C and ABO-I DDLT groups were followed up for 49.6 and 43.6 months, respectively. Following 1:1 propensity score matching (n=110 per group), the ABO-I group exhibited lower survival rates compared to the ABO-C group at 1, 3, and 5 years (74.0%, 68.5%, and 65.5% vs 88.0%, 83.0%, and 80.7%; P = 0.024). Multivariate analysis identified age > 65 years, liver cancer pre-transplantation, intraoperative blood loss > 1000 mL, and diffuse intrahepatic biliary stricture (DIHBS) as independent risk factors for patient survival. Crucially, after excluding DIHBS, survival outcomes between the two groups were comparable (P = 0.336).
Conclusion:
Emergent ABO-I LT with an adjusted desensitization protocol is feasible but associated with inferior survival due to a higher incidence of DIHBS. This disparity underscores the need for refined strategies to mitigate DIHBS and improve ABO-I LT outcomes.
