ABO Incompatability in Liver Transplantation

Abstract

Despite the great potential of ABO-incompatible (ABOi) liver transplantation (LT) for expanding the donor pool, serious concern about poor outcomes in the recipients has been a major obstacle to its widespread. The use of ABOi living donors is an attractive solution for expanding the liver donor pool, and various novel strategies for desensitization of ABO incompatibility have yielded promising results. The 1st breakthrough was local graft infusion therapy introduced by the Keio and Kyoto group; a second, epochal advance was the advent of the anti-CD20 monoclonal antibody, rituximab. Since then, the risk of fulminant hepatic necrosis caused by full-blown antibody-mediated rejection (AMR) has almost disappeared, and survival outcomes of ABOi LT have increased markedly. In the Korean experience, ABOi LT accounts for 18% of all adult living donor liver transplantation, and 3-year graft and patient survival rates are 86.5 and 87.6%, respectively. ABOi living donor LT is thus having a major impact on the donor pool and the recent achievements permit us to promote a nationwide ABOi LT program. However, concern still remains about diffuse intrahepatic biliary stricture (DIHBS), which is an attenuated form of AMR. Ultimately, we need to identify risk factors and preventive measures for this.