Current Status of ABO-incompatible Liver Transplantation

Abstract

By 2014, strategies to prevent antibody-mediated rejection (AMR) after ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) were established in Japan and expanded primarily to Asia, where LDLT is now the predominant form of LT owing to the scarcity of brain-dead donors. A desensitization protocol consisting of rituximab (375 mg/m 2 ), plasma pheresis, tacrolimus, and mycophenolate mofetil before LDLT, followed by standard immunosuppression, is currently the best option in terms of safety and efficacy. Rituximab administration is now known not to increase the risk of hepatocellular carcinoma recurrence, and the feasibility of rituximab for LDLT for acute liver failure and the need for desensitization before LDLT in children older than 1 y have been documented. Strategies are needed to distinguish patients at high risk of AMR from those at low risk and to adjust immunosuppression to prevent both AMR and infection. Specific single-nucleotide polymorphisms in genes encoding Fcγ receptors affecting the cytotoxicity of rituximab on B cells could be useful for adjusting immunosuppression levels to decrease infectious complications. Immunological accommodation after ABO-I transplantation could be provided by immune factors in both the grafts and recipients.

Machine Learning Model Validated to Predict Outcomes of Liver Transplantation Recipients with Hepatitis C: The Romanian National Transplant Agency Cohort Experience

“…Therefore, it is important for healthcare providers to consider the individual patient’s risk factors, including gender, when assessing their risk for post-liver transplant complications and developing a comprehensive care plan. Additionally, pre-transplant laboratory parameters, such as ABO blood type, can also play a role in predicting the risk of complications [ 36 ]. A study showed that patients with an ABO blood type mismatch between the donor and recipient have an increased risk of acute rejection [ 36 ].…”

“…Additionally, pre-transplant laboratory parameters, such as ABO blood type, can also play a role in predicting the risk of complications [ 36 ]. A study showed that patients with an ABO blood type mismatch between the donor and recipient have an increased risk of acute rejection [ 36 ]. Therefore, the pre-transplant parameters can help in predicting complications, allowing for more proactive and tailored management strategies.…”

CAQ Corner: Evaluation and management of living liver donors

“…As previously mentioned, complete laboratory testing, including blood type, liver function tests, serologic evaluation to rule out underlying chronic liver disease, and subclinical coagulation disorders, should be performed (Table 1). Donors, in general, should be blood type compatible or identical although there are some data for ABO incompatibility, especially from Asian countries with the use of rituximab for desensitization 23 …”

Evaluating the Potential for ABO-incompatible Islet Transplantation: Expression of ABH Antigens on Human Pancreata, Isolated Islets, and Embryonic Stem Cell-derived Islets

“…For kidney, heart, and liver transplantation, ABOi transplantation has achieved clinical outcomes nearly equivalent to those observed following ABOc transplant. [10][11][12][13][14][15][16][17] Application of ABOi organ transplant occurred in response to donor supply limitations, which has substantially increased the capacity to transplant these organs. 10,12,13,18 Achieving these outcomes in other fields has required modified induction immunosuppression to limit acute rejection.…”

“…10,12,13,18 Achieving these outcomes in other fields has required modified induction immunosuppression to limit acute rejection. 16,[19][20][21] However, overcoming acute rejection following ABOi ITx by relying on immunosuppression alone is unlikely to be clinically feasible because islets have comparatively greater susceptibility to acute rejection because of their increased exposure to the immune system as a cell suspension. 5 Furthermore, islet transplants, although purified, typically still have substantial contamination by pancreatic exocrine tissue components, and even purified islet preparations remain only 30% to 50% pure.…”