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ABO Incompatible Deceased Donor Liver Transplants in Infants (Age < 1 Year): A Single-Center Experience
Heli Bhatt1, Sarah Kizilbash1, Claudia Cohn2
1Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Insights
ABO incompatible (ABOi) liver transplants in infants under 1 year are safe and effective. This approach, without plasmapheresis, shows comparable survival rates to ABO-compatible transplants and reduces wait times for infant liver transplantation.
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.
Background:
The liver transplant waitlist mortality for infants (age < 1 year) is currently the highest, listed at 20 per 100 years of waiting time. ABO incompatible (ABOi) liver-transplantation is one of the strategies to increase transplantation rate in infants but utilized only in 5.6% of infants.
Methods:
At our center, all children < 1 year are listed for ABOi liver transplants. If the anti-ABO titers are less than 1:8, no plasmapheresis was used. Thymoglobulin is used for induction. We analyzed the transplant outcomes of patients that received ABOi livers compared to ABOc livers.
Results:
Sixteen infants, who received ABOi liver-transplants are compared to 56 ABO-compatible (ABOc) infant liver transplants. ABOi group utilized AB or B blood type livers 81%, compared to none in the ABOc group. The 1-, 5-, and 10-year survival in the ABOi group remains at 81% and is comparable to survival in the ABOc group. None of the ABOi patients developed antibody-mediated rejection or intrahepatic biliary strictures. None of the ABOi patients had hepatic artery thrombosis, compared with 4 (7.1%) in the ABOc group (p = 0.64). There is no difference in infectious complications. The median wait times for patients < 1 year for blood types A, B, AB, and were 96, 109, 82 days and 126 respectively. The patients listed to accept ABOi livers had a shorter waiting time (p = < 0.001).
Conclusions:
This study shows that ABOi liver transplants can be safely performed in children less than1 year of age without plasmapheresis, with excellent long-term outcomes.
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