A260 OUTCOMES OF LIVER TRANSPLANTATION FOR ACUTE LIVER FAILURE AMONG RECIPIENTS WITH ABO-IDENTICAL VS. ABO-COMPATIBLE VS ABO-INCOMPATIBLE GRAFTS
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Acute liver failure is associated with a high mortality rate due to multi-organ failure, sepsis and cerebral edema. Liver transplantation remains the only life saving treatment available for these critically ill patients. Urgent liver transplantation within 48 to 72 hours has shown to be crucial for reducing the waiting list mortality of these patients. However, liver grafts are a scarce resource, leading to a significant rate of mortality for patients in need of urgent liver transplant. ABO-incompatible (ABO-in) liver transplantation is occasionally used as a rescue alternative when an ABO-identical (ABO-id) or compatible (ABO-c) graft is not available. The outcomes of ABO-in liver transplantation using deceased donors have been variable but mostly reported to be associated with poor graft function, early graft loss and an increased rate of complications. There are however limited studies examining long term outcomes of liver transplantation with ABO-in grafts. The aim of the study was to compare long term mortality and graft survival of patients undergoing liver transplantation with ABO-id vs. ABO-c and ABO-in donor grafts. A secondary objective was to determine other predictors of poor outcome in patients requiring urgent liver transplantation for acute liver failure. A retrospective cohort study was done to examine adult patients who underwent urgent liver transplantation between 1985 and 2016 in London, Ontario. Patients were divided into three cohorts depending on their grafts’ ABO compatibility: ABO-id, ABO-c and ABO-in. Transplant outcomes in the peri and post transplant period were collected for all three cohorts. Multivariate logistic regression was used to assess ABO-compatibility as a predictor of graft failure and patients’ death. 73 patients with emergency liver transplantation were studied. Of those, 9.6% received an ABO-in graft. Rate of retransplantation in ABO-id, ABO-c and ABO-in groups was 2.5%, 11.5% and 57%, respectively. The OR of graft failure in the ABO-in group was 13 times greater when compared to ABO-id (OR 13.3, p 0.02). There was no statistically significant difference in graft survival between ABO-c and ABO-id groups (OR 3.5, p 0.12). OR of death was not significantly different between the three groups. Age (OR 1.06, p0.04), need for inotropic support (OR 6.2, p0.02) and stroke (OR 15.2, p0.03) were more important predictors of death than ABO compatibility itself. ABO-in liver transplantation was associated with higher rates of graft failure and retransplantation however there was no significant difference in long term mortality in these patients. In select adult patients with acute liver failure in need of an emergency liver transplantation, ABO-in transplants should be viewed as an important lifesaving therapeutic option with comparable results in long term survival. NoneKeywords:
ABO incompatibility
We performed 13 pediatric liver transplants from ABO-incompatible living related maternal or paternal donors using a combination of preoperative removal of isohemagglutinin and postoperative immunosuppressive therapy with FK506 and prophylactic OKT3. Tissue near-infrared spectroscopy was applied to evaluate hemodynamics using the hemoglobin of red cells in the sinusoids as an index. The data obtained indicated that the preoperative removal of isohemagglutinin prevented hyperacute humoral rejection with hemorrhagic infiltration in the sinusoids in 10 successful cases. The incidence of acute rejection was not significantly different among ABO-identical, -compatible, and -incompatible groups. The estimated 1-year survival rate of the ABO-incompatible group was 77%.
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Objectives: Children under 1 year have the highest mortality on the heart transplant waiting list (HTX). However, ~15% of donor organs under 2 years of age cannot be mediated in the absence of suitable recipients. In comparison to the ABO-compatible (ABOc), the ABO-incompatible (ABOi) HTX is a possibility to mediate as many donor organs as possible.
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Background: ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) is gradually being implemented to overcome the shortage of donor kidneys.Since ABOi LDKT began in 2007 in Korea, there have not been yet sufficient reports regarding the posttransplant long term outcomes including the incidence of rejection of ABOi LDKT.We analyzed the decade of our experiences of ABOi LDKT with comparing ABO-compatible (ABOc) LDKT from the standpoint of rejection and de novo donor-specific alloantibody (DSA).Methods: We retrospectively analyzed 1,190 living donor kidney transplant recipients between July 2010 and December 2020 at the Severance Hospital.We compared clinical outcomes and rejection type of ABOi LDKT (n=246) with those of ABOc LDKT (n=749).Results: No significant difference in death-censored graft survival was observed between ABOi KT and ABOc KT (P=0.217).Patient survival after ABOi KT was similar to that after ABOc KT (95.0% vs. 97.3%,respectively; P=0.108).The prevalence of de novo DSA production and biopsy-proven acute T-cell mediated rejection (TCMR) and chronic antibody-mediated rejection (ABMR) were comparable between the two groups.The incidence of biopsy-proven active ABMR was significantly higher ABOi KT than ABOc KT (9.8% [24/246] vs. 5.5% [41/749], respectively; P=0.018).In addition, biopsy-proven acute rejection (BPAR) free survival rate was lower in ABOi KT than ABOc KT (71.8% vs. 76.4%,respectively; P=0.024).Multivariable cox regression confirmed that DR and DQ associated de novo DSA was independently associated BPAR but ABO incompatibility was not a significant risk factor of BPAR after adjustment with covariates.Conclusions: ABOi LDKT was not inferior to ABOc LDKT for patient survival and graft survival.However, ABO incompatibility was associated with the increased incidence of active ABMR.
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Abstract The ABO incompatibility between donor and recipient is not considered a barrier to successful allogeneic HSCT . Nevertheless, conflicting data still exist about the influence of ABO incompatibility on transplant outcome in pediatric patients with thalassemia. Fifty‐one children with beta‐thalassemia major who underwent allogeneic HSCT were enrolled this study. Twenty‐three of them (45%) received an ABO ‐incompatible transplant [minor ABO mismatch: six (26%), major ABO mismatch: fourteen (61%), and bidirectional mismatch: three (13%)]. In this study, ABO incompatibility did not significantly impair GVHD , VOD , neutrophil and platelet engraftment, TRM , OS and TFS . Particularly in major and bidirectional ABO ‐mismatched patients, a delayed erythroid recovery was recorded as compared to the group receiving an ABO ‐compatible graft (median time, 31 and 38 days vs. 19.5 days; p: 0.02 and p: 0.03). Median time to red cell transfusion independence was significantly longer in major ABO ‐incompatible patients (median time, 87 days vs. 32 days; p: 0.001). Therefore, whenever feasible, major ABO ‐mismatched donors should be avoided in HSCT recipients, to prevent delayed erythroid recovery with prolonged RBC transfusion needs and impaired quality of life.
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