ABO Incompatible Deceased Donor Liver Transplants in Infants (Age < 1 Year): A Single-Center Experience

Area of Science:

• Pediatric Surgery
• Transplantation Immunology
• Hepatology

Background:

• Infant liver transplant waitlist mortality is high (20 per 100 patient-years).
• ABO incompatible (ABOi) liver transplantation is underutilized in infants (5.6%).

Purpose of the Study:

• Evaluate the safety and efficacy of ABOi liver transplants in infants (<1 year).
• Compare outcomes of ABOi vs. ABO-compatible (ABOc) infant liver transplants.

Main Methods:

• Infants (<1 year) were listed for ABOi liver transplants.
• No plasmapheresis used if anti-ABO titers < 1:8.
• Thymoglobulin used for induction.

Main Results:

• ABOi group (16 infants) showed comparable 1-, 5-, and 10-year survival (81%) to ABOc group (56 infants).
• No antibody-mediated rejection or biliary strictures in ABOi group.
• Shorter median wait times observed for infants accepting ABOi livers (p < 0.001).

Conclusions:

• ABOi liver transplantation is safe and effective in children under 1 year.
• This strategy improves transplant rates without compromising long-term outcomes.
• Eliminates the need for plasmapheresis in select infant ABOi liver transplant cases.