Impact of ABO-incompatibility on hepatic artery thrombosis in living donor liver transplantation

Abstract

Background: The current era of rituximab-based regimens brought improved survival in ABO-incompatible (ABO-I) living donor liver transplantation (LDLT). Nevertheless, the actual risk for hepatic artery thrombosis (HAT) still remains to be investigated. The aim of this study was to evaluate the impact of ABO-incompatibility on HAT in adult LDLT patients. Methods: Patients who received ABO-I LDLT were compared to those who received ABO-compatible (ABO-C) LDLT with a special focus on HAT. Results: A total of 378 patients underwent LDLT from January 2012 to February 2018. Of those, ABO-I LDLT was performed in 78 consecutive patients. The other 300 patients with ABO-C LDLT constituted the comparator group. No significant differences were observed between the two groups in baseline and perioperative characteristics. HAT occurred in 11 (2.9%) patients, 2 and 9 patients in ABO-I and ABO-C LDLT groups, respectively, which didn’t show any significant difference between the two groups (P=0.84). All were categorized into early HAT. Immediate revascularization by intraarterial thrombolysis was successfully employed in 8 patients. Surgical revision of anastomosis and retransplantation were performed in 1 and 2 patients, respectively. No one-year mortality was related to HAT in the two groups. The overall outcomes including biliary complications made no significant difference between the two groups. Conclusions: ABO-incompatibility has no adverse impact on the incidence and treatment outcome of HAT in the current rituximab-based desensitization.