ABO Incompatible Liver Transplantation in Children: A 20 Year Experience from Centres in the TransplantChild European Reference Network

Abstract

An increasing number of AB0-incompatible (AB0i) liver transplantations (LT) are being undertaken internationally in recent years due to organ shortages and the need for urgent transplantation. The aim of our study was establish the value of ABOi LT from available retrospective results of AB0i pediatric liver transplantations performed in European reference centers now belonging to the TransplantChild, European Reference Network (ERN). Data from medical records were analyzed, including demographic data, diagnosis, urgency of transplantation, time on the waiting list, PELD/MELD score, desensitization procedures, immunosuppression, selected post-transplant complications, and patient and graft survival. A total of 142 patients (pts) with transplants between 1986 and 2018 in 8 European transplant centers were included in the study. The indications for liver transplantation were: cholestatic diseases in 62 pts, acute liver failure in 42 pts, and other conditions in the remaining 38 pts. Sixty-six patients received grafts from living donors, and seventy-six received grafts from deceased donors. Both patient and graft survival were significantly affected by deceased donor type, urgent transplantation, and the development of vascular complications. In the multivariate analysis, vascular complications had a negative impact on patient and graft survival, while a longer time from the first AB0i LT in the study showed better results, suggesting an international learning experience. In conclusion, we believe that AB0i LT in children is now a safe procedure that may be adopted more readily in children.

Current Status of ABO-incompatible Liver Transplantation

“…In particular, patient mortality after 2011 (19%) was significantly lower ( P < 0.05) than that before 2011 (33%). However, mortality was higher in the TRANSPLANT-CHILD patient cohort 46 than in others. 44,45…”

“…In particular, patient mortality after 2011 (19%) was significantly lower (P < 0.05) than that before 2011 (33%). However, mortality was higher in the TRANSPLANT-CHILD patient cohort 46 than in others. 44,45 New Complications Associated With ABO-I LDLT AMR and infections are the most common complications of ABO-I LDLT.…”

“…Finally, additional plasmapheresis was performed on day 1 before ABO-I LT when isoagglutinin titers remained at 1:16 or higher despite the previous preparation protocol. 45 The report on the 20-y experience of the TRANSPLANT-CHILD European Reference Network 46 included 142 patients who underwent LDLT between 1986 and 2018 at 8 European transplant centers. Before ABO-I LT, pre transplantation desensitization of children was very uncommon at European centers, with high-dose IVIG being administered more often than other alternatives, but only in 8% of recipients.…”

Outcomes after ABO incompatible pediatric liver transplantation are comparable to ABO identical/compatible transplant

“…A recent multicenter European collaborative report described the outcomes after ABOi and presented the various perioperative medical management strategies for ABOi LT ( 8 ). There was a high variability in practice, with no one strategy superior to the others.…”

“…Patient and graft survival were also noted to be lower than with ABO identical or compatible (ABOc) grafts ( 5 , 6 ). However, recently published studies showed improved outcomes after ABOi ( 7 , 8 ). The age of the recipient was shown to be an important predictive factor of outcomes, where age greater than 1 year at the time of ABOi LT was associated with an increased morbidity and mortality ( 9 , 10 ).…”