Clinical efficacies of ABO-incompatible adult liver transplantation

Objective: To evaluate the efficacy and safety of ABO-incompatible liver transplantation in adult patients with fulminant hepatitis B. Methods: The clinical data of 97 cases of adult liver transplantation for fulminant hepatitis B were retrospectively analyzed. The patients were grouped as ABO-identical (ABO-Id, n=58), ABO-compatible (ABO-C, n=19) and ABO-incompatible (ABO-In, n=20). The rates of rejection, infection, biliary tract complications, vascular complications, and patient and graft survivals were compared among 3 groups. Results: The 3-month, 1-year and 3-year graft survival rates were 87.9%/77.6%/65.3% in ABO-Id group, 84.2%/73.7%/66. 5% in ABO-C group and 50.0%/35.0%/33.3% in ABO-In group respectively. There were significant differences between ABO-Id and ABO-In (P < 0.05). The incidences of rejection, infection, vascular complications and biliary tract complications were 8.6%, 20.7%, 3.4% and 6.9% in ABO-Id group, 35%, 60%, 20% and 30% in ABO-In group (P < 0.05) and 10.5%, 26.3%, 5.3% and 10.5% respectively in ABO-C group (P > 0.05). Conclusion: ABO-C liver transplantation is an important therapeutic option in adult patients with acute liver failure awaiting an emergency procedure. ABO-In transplantation can be used only for life-rescuing in patients with fulminant hepatitis since it is associated with a higher risk of rejection, infection, vascular thrombosis, ischemic bile duct complications and poor patient and graft survival.