Comparison of clinical outcomes between ABO-incompatible and ABO-compatible pediatric liver transplantation: a systematic literature review and meta-analysis

Kang, Zhong-Yu; Liu, Wei; Li, Dai‐Hong

doi:10.1007/s00383-020-04746-5

Cited by 5 publications

(4 citation statements)

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“…Indeed, ABO‐incompatible transplantation has been shown to be a risk factor for hepatic artery thrombosis. [ 45–48 ] Although a recent meta‐analysis of pediatric ABO‐incompatible transplantation did not confirm this, [ 49 ] it may be influenced by small sample size and immunomodulatory strategies applied during emergency transplantation across ABO barriers. An alternative hypothesis is that HLA‐A mismatching may increase graft rejection, with resultant hepatic inflammation and infiltration contributing to elevated vascular resistance, vascular stasis, and elevated risk of thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, ABO-incompatible transplantation has been shown to be a risk factor for hepatic artery thrombosis. [45][46][47][48] Although a recent meta-analysis of pediatric ABO-incompatible transplantation did not confirm this, [49] it may be influenced by small sample size and immunomodulatory strategies applied during emergency transplantation across ABO barriers. An Note: Data are presented as n or n (%) or median (IQR).…”

Section: Discussionmentioning

confidence: 99%

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Donor–recipient human leukocyte antigen A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss, and reduced survival after liver transplant

et al. 2022

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Human leukocyte antigen (HLA) matching is not routinely performed for liver transplantation as there is no consistent evidence of benefit; however, the impact of HLA mismatching remains uncertain. We explored the effect of class I and II HLA mismatching on graft failure and mortality. A total of 1042 liver transplants performed at a single center between 1999 and 2016 with available HLA typing data were included. The median follow‐up period was 9.38 years (interquartile range 4.9–14) and 350/1042 (33.6%) transplants resulted in graft loss and 280/1042 (26.9%) in death. Graft loss and mortality were not associated with the overall number of mismatches at HLA‐A, HLA‐B, HLA‐C, HLA‐DR, and HLA‐DQ loci. However, graft failure and mortality were both increased in HLA mismatching on graft failure and mortality the presence of one (p = 0.004 and p = 0.01, respectively) and two (p = 0.01 and p = 0.04, respectively) HLA‐A mismatches. Elevated hazard ratios for graft failure and death were observed with HLA‐A mismatches in univariate and multivariate Cox proportional hazard models. Excess graft loss with HLA‐A mismatch (138/940 [14.7%] mismatched compared with 6/102 [5.9%] matched transplants) occurred within the first year following transplantation (odds ratio 2.75; p = 0.02). Strikingly, transplants performed at a single all grafts lost due to hepatic artery thrombosis were in HLA‐A–mismatched transplants (31/940 vs. 0/102), as were those lost due to sepsis (35/940 vs. 0/102). In conclusion, HLA‐A mismatching was associated with increased graft loss and mortality. The poorer outcome for the HLA‐mismatched group was due to hepatic artery thrombosis and sepsis, and these complications occurred exclusively with HLA‐A–mismatched transplants. These data suggest that HLA‐A mismatching is important for outcomes following liver transplant. Therefore, knowledge of HLA‐A matching status may potentially allow for enhanced surveillance, clinical interventions in high‐risk transplants or stratified HLA‐A matching in high‐risk recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Donor–recipient human leukocyte antigen A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss, and reduced survival after liver transplant

et al. 2022

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“…Graft survival could be comparable in pediatric patients and those using rituximab. However, another more recent systematic review and meta-analysis by Kang et al [ 16 ] showed consistently lower patient and graft survival with pediatric ABO-incompatible LT than the ABO-compatible group. The authors concluded that ABO-incompatible LT is an important choice to consider for emergency LT in the absence of blood type-matching liver source although it is not an optimal treatment in terms of graft and patient survival rates.…”

Section: Discussionmentioning

confidence: 99%

Pediatric liver transplantation outcomes from a single center in Thailand

Prachuapthunyachart¹,

Sintusek²,

Tubjareon³

et al. 2022

WJH

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BACKGROUND Liver transplantation (LT) has become an acceptable curative method for children with several liver diseases, especially irreversible acute liver failure and chronic liver diseases. King Chulalongkorn Memorial Hospital is one of Thailand’s largest liver transplant centers and is responsible for many pediatric cases. AIM To report the experience with pediatric LT and evaluate outcomes of living-related vs deceased-donor grafts. METHODS This evaluation included children who underwent LT between August 2004 and November 2019. Data were retrospectively reviewed, including demographics, diagnoses, laboratory values of donors and recipients, the pediatric end-stage liver disease (PELD) or model for end-stage liver disease (MELD) score, graft source, wait time, perioperative course, postoperative complications, and survival rates. Continuous data were reported using the median and interquartile range. The Mann–Whitney U- test was used to compare the wait time between the living-related and deceased-donor groups. The chi-square or Fisher's exact test were used to compare the frequencies of between-group complications. Survival rates were calculated using the Kaplan–Meier method. RESULTS Ninety-four operated pediatric liver transplant patients were identified (54% were females). The median age at transplantation was 1.2 (0.8-3.8) years. The median PELD and MELD scores were 20 (13-26.8) and 19.5 (15.8-26.3), respectively. Most grafts (81.9%) were obtained from living-related donors. The median wait time for the living donors was significantly shorter compared with the deceased donors at 1.6 (0.3-3.1) mo vs 11.2 (2.1-33.3) mo ( P = 0.01). Most patients were diagnosed with biliary atresia (74.5%), and infection was the most common complication within 30 d post-transplantation (14.9%). Without a desensitization protocol, 9% of transplants were ABO-incompatible. Eight hepatitis B core antibodies (anti-HBc)-negative recipients received positive anti-HBc grafts without different observed complications. The overall survival rate was 93.6% and 90.3% at 1 and 5 years, respectively. No graft loss during follow-up was noted among survivors. CONCLUSION A significant number of pediatric LT cases were reported in Thailand. Based on relatively comparable outcomes, ABO-incompatible and HBc antibody-positive grafts may be considered in an organ shortage situation.

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“…ABO‐incompatible LT is an effective way to save the lives of patients with end‐stage liver disease in emergency situations. However, previous studies in China have found that although there is little difference in the complication rates after the transplantation of ABO‐incompatible or ABO‐compatible donor livers, 20 the 1‐, 3‐ and 5‐year graft and patient survival rates of patients receiving ABO‐incompatible donor livers are significantly lower than those of patients who received ABO‐compatible donor livers 21 . The transplantation of an ABO‐incompatible donor liver was an independent prognostic factor affecting overall survival after living donor liver transplantation 22 and might be related to the extrahepatic recurrence of liver cancer after LT.…”

Section: Future Perspectivesmentioning

confidence: 97%

Liver transplantation in patients with liver failure: Twenty years of experience from China

2022

Liver International

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Liver failure means that the liver is not working well enough to perform its functions, such as synthesis, detoxification, metabolism and biotransformation. The symptoms of liver failure include jaundice, coagulopathy, hepatorenal syndrome, hepatic encephalopathy and ascites. Based on patient medical history and disease onset and progression, liver failure can be divided into four categories: acute liver failure (ALF), subacute liver failure (SALF), acute-on-chronic liver failure (ACLF) and chronic liver failure (CLF). 1 In China, the causes of liver failure mainly include infection with hepatitis viruses (mainly hepatitis B virus, HBV) and the use of alcohol and drugs. 1 Liver transplantation

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Comparison of clinical outcomes between ABO-incompatible and ABO-compatible pediatric liver transplantation: a systematic literature review and meta-analysis

Cited by 5 publications

References 41 publications

Donor–recipient human leukocyte antigen A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss, and reduced survival after liver transplant

Donor–recipient human leukocyte antigen A mismatching is associated with hepatic artery thrombosis, sepsis, graft loss, and reduced survival after liver transplant

Pediatric liver transplantation outcomes from a single center in Thailand

Liver transplantation in patients with liver failure: Twenty years of experience from China

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