Recipient Outcomes after ABO-Incompatible Liver Transplantation: A Systematic Review and Meta-Analysis

Abstract

BackgroundABO-incompatible live transplantation (ILT) is not occasionally performed due to a relative high risk of graft failure. Knowledge of both graft and patient survival rate after ILT is essential for donor selection and therapeutic strategy. We systematically reviewed studies containing outcomes after ILT compared to that after ABO-compatible liver transplantation (CLT).Methodology/Principal FindingsWe carried out a comprehensive search strategy on MEDLINE (1966–July 2010), EMBASE (1980–July 2010), Biosis Preview (1969–July 2010), Science Citation Index (1981–July 2010), Cochrane Database of Systematic Reviews (Cochrane Library, issue 7, 2010) and the National Institute of Health (July 2010). Two reviewers independently assessed the quality of each study and abstracted outcome data. Fourteen eligible studies were included which came from various medical centers all over the world. Meta-analysis results showed that no significantly statistical difference was found in pediatric graft survival rate, pediatric and adult patient survival rate between ILT and CLT group. In adult subgroup, the graft survival rate after ILT was significantly lower than that after CLT. The value of totally pooled OR was 0.64 (0.55, 0.74), 0.92 (0.62, 1.38) for graft survival rate and patient survival rate respectively. The whole complication incidence (including acute rejection and biliary complication) after ILT was higher than that after CLT, as the value of totally pooled OR was 3.02 (1.33, 6.85). Similarly, in acute rejection subgroup, the value of OR was 2.02 (1.01, 4.02). However, it was 4.08 (0.90, 18.51) in biliary complication subgroup.Conclusions/SignificanceIn our view, pediatric ILT has not been a contraindication anymore due to a similar graft and patient survival rate between ILT and CLT group. Though adult graft survival rate is not so satisfactory, ILT is undoubtedly life-saving under exigent condition. Most studies included in our analysis are observational researches. Larger scale of researches and Randomized-Control Studies are still needed.

Impact of psoas muscle index on short-term outcome after living donor liver transplantation

“…It has been reported that ABO-mismatch recipients have a higher risk of acute rejection (32). In the present study, 2 out of 6 recipients with ABO-incompatible liver grafts developed acute rejection.…”

“…However, it has been said that the outcome of LDLT performed for patients with acute liver failure, including fulminant hepatitis, is good (32). Among the 47 patients enrolled in the present study, there were only 4 with acute liver failure.…”

ABO-Incompatible Adult Living Donor Liver Transplantation Under the Desensitization Protocol With Rituximab

“…Since the introduction of desensitization (DSZ) with the anti-CD20 monoclonal antibody rituximab (RIT), the risk of hepatic necrosis caused by full-blown AMR has almost disappeared, and overimmunosuppression aimed at avoiding AMR is no longer required (5,6). Nonetheless, most reports on the clinical outcomes of ABOi ALDLT in the literature still include unfavorable outcome data from before the RIT era, leading to overestimation of the morbidity rate and underestimation of the survival rate of current ABOi ALDLT (7). As such, misconceptions about unacceptable clinical outcomes of ABOi ALDLT persist and limit the widespread application of ABOi ALDLT.…”

ABO-Incompatible Living Donor Liver Transplantation in Focus of Antibody Rebound

“…Hepatic artery thrombosis occurred in 24% of ABOi allografts [3,28]. The metaanalysis of Wu et al [2] in 2011 showed the total complication incidence and acute rejection incidence to be higher after ABOi LDLT than after ABOc LT. Lee at al. [23] performed ABOi LDLT with a protocol of plasmapheresis, IVIG, and quadruple immunosuppressive therapy (basiliximab, tacrolimus, mycophenolate mofetil, steroids).…”