en
Scientific article
English

ABO-incompatible liver transplantation for critically ill adult patients

Published inTransplant international, vol. 20, no. 8, p. 675-681
Publication date2007
Abstract

ABO incompatible (ABO-In) liver transplant remains a controversial solution to acute liver failure in adults. Adult liver recipients with acute liver failure or severely decompensated end-stage disease, intubated and/or in the intensive care unit, were grouped as ABO-In (n = 14), ABO-compatible (n = 29, ABO-C) and ABO-identical (n = 65, ABO-Id). ABO-In received quadruple immunosuppression with antibody-depleting induction agents (except two), calcineurin inhibitors, antimetabolites and steroids. No significant difference of patient and graft survivals was observed among ABO-In, ABO-C and ABO-Id: graft survivals were 64%, 62% and 67%, respectively, in 1 year and 56%, 54% and 60%, respectively, in 5 years; patient survivals 86%, 69% and 67%, respectively, in 1 year and 77%, 61% and 62%, respectively, in 5 years. Three ABO-In grafts were lost (one hyper-acute rejection and two hepatic artery thrombosis). Surgical and infectious complications were similarly distributed between groups, except the hepatic artery thrombosis, more frequent in ABO-In (2, 14%) than ABO-I (1, 1.5%, P < 0.05). In contrast to previous studies, no significant difference of patient and graft survivals could be observed among all ABO-compatibility settings. Our results suggest that ABO-incompatible transplants should be viewed as an important therapeutic option in adult patients with acute liver failure awaiting an emergency procedure.

Keywords
  • ABO Blood-Group System/immunology
  • Adolescent
  • Adult
  • Aged
  • Alberta/epidemiology
  • Critical Illness
  • Female
  • Follow-Up Studies
  • Graft Rejection/blood/epidemiology/prevention & control
  • Graft Survival
  • Humans
  • Immunosuppressive Agents/therapeutic use
  • Incidence
  • Liver Failure/blood/surgery
  • Liver Transplantation/adverse effects
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Survival Rate
Citation (ISO format)
TOSO, Christian et al. ABO-incompatible liver transplantation for critically ill adult patients. In: Transplant international, 2007, vol. 20, n° 8, p. 675–681. doi: 10.1111/j.1432-2277.2007.00492.x
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Article (Published version)
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Identifiers
ISSN of the journal0934-0874
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