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Outcomes of Pediatric ABO-Incompatible Living Donor Liver Transplantation: A Retrospective Single-Centre Experience
Jagadeesh Menon1, Prithviraj Nabi1, Deepti Sachan1
1The Institute of Liver Disease & Transplantation, Dr Rela Institute & Medical Centre, Bharath Institute of Higher Education and Research, Chennai, India.
Insights
ABO incompatible liver transplant (ABOi-LT) in children offers excellent survival rates. Effective desensitization protocols are key to successful pediatric ABOi-LT outcomes.
Area of Science:
- Pediatric Transplant Surgery
- Immunology
- Hepatology
Background:
- ABO incompatible liver transplant (ABOi-LT) is a vital alternative for pediatric liver transplantation (LT) when compatible donors are unavailable.
- Experience with pediatric ABOi-LT, particularly from developing regions, is limited.
Purpose of the Study:
- To analyze the center's experience with ABO incompatible liver transplant in children.
- To evaluate clinical profiles, desensitization protocols, complications, and survival rates.
Main Methods:
- Retrospective analysis of pediatric ABOi-LT cases from January 2011 to February 2024.
- Evaluation of patient demographics, etiology, desensitization strategies (plasmapheresis, rituximab, immunoadsorption), and post-transplant outcomes.
Main Results:
- 35 pediatric ABOi-LTs were performed, with biliary atresia being the most common indication (63%).
- High rates of desensitization were achieved using plasmapheresis and rituximab, with no major pre-transplant infections.
- Excellent patient survival (97%) and graft function were observed, with successful treatment of antibody-mediated rejection (AMR).
Conclusions:
- Pediatric ABO incompatible liver transplant can achieve excellent outcomes.
- Effective desensitization protocols are crucial for successful pediatric ABOi-LT.
Background/Aims:
ABO incompatible liver transplant (ABOi-LT) is an essential alternative to blood-group-compatible liver transplant (LT) in children, and there is limited experience with this, especially from the developing world. The current analysis focuses on our experience of ABOi-LT in children.
Method:
A retrospective analysis of all children undergoing ABOi-LT at our centre from January 2011 to February 2024 was performed. Their clinical profile, desensitisation protocol, post-transplant complications, patient and graft survival were analysed.
Results:
We performed 35 (5%) ABOi-LTs during the above-mentioned time period. The median (interquartile range [IQR]) age at ABOi-LT was 15 (10-72) months, and the commonest aetiology was biliary atresia in 22 (63%) patients. Nineteen (54%) patients were below 18 months of age. Pre-LT plasmapheresis was offered to 24 (64%) patients, and 24 (64%) received rituximab. In children less than 18 months of age, 8 (42%) received pre-LT rituximab. None of the patients had major infections secondary to rituximab in the pre-LT period. Post-LT plasmapheresis was offered to 20 (57%) patients and 5 (15%) required immunoadsorption for persistently high antibody titres. Acute T-cell-mediated rejection was seen in 6 (17%) and 2 (5.5%) patients developed antibody-mediated rejection (AMR). No patients had hepatic artery thrombosis, anastomotic biliary strictures or bile leaks and 1 (2.7%) had chronic portal vein thrombosis. The median (IQR) duration of hospital stay was 16 (14-19.5) days. After a median follow-up of 24 months, overall survival was 34 (97%). Two patients with AMR were successfully treated and have normal graft function on follow-up.
Conclusion:
Excellent outcomes post-ABOi-LT can be achieved in children by using effective desensitisation protocols.
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