Clinical Evaluation And Prognostic Analysis Of ABO-incompatible Liver Transplantation

BackgroundLiver transplantation has become the best method to treat various end-stage liver diseases with rapid development.However,due to the imbalance in the number of donors and recipients,a large number of critically ill patients have to accept ABO-incompatible liver transplantation in order to save their lives.The efficacy has been controversial because it is thought to lead to increased postoperative complications and poor prognosis.MethodsA retrospective analysis was conducted on 304 patients who received liver transplantation from the First Affiliated Hospital,School of Medicine,Zhejiang University from January 1,2015 to December 31,2017.The patients were divided into two groups:the ABO-compatible group and the ABO-incompatible group.The survival and complications of the two groups were analyzed and compared.The preoperative MELD score was stratified to further analyze the effect of MELD score on the survival of patients with ABO-incompatible liver transplantation.ResultsThere was no significant increase in the incidence of complications after ABO-incompatible liver transplantation compared with the ABO-compatible group.The 1-year,2-year and 3-year cumulative survival rates were 79.3%,71.3%,67.6%and 59.7%,57.4%,49.8%,respectively in the ABO-compatible and ABO-incompatible groups,with statistically significant differences(P=0.006).The 1-year,2-year,3-year cumulative survival rates were 71.4%,64.2%,61.1%and 52.0%,48.5%,43.3%,respectively in the ABO-compatible and ABO-incompatible groups with high MELD scores(P=0.130).ConclusionsThe survival rate of ABO-incompatible group is lower than that of ABO-compatible group,and the incidence of postoperative complications such as rejection,biliary and vascular complications is relatively higher.For recipients with high MELD scores,there was no significant difference in survival between these two groups.Therefore,ABO-compatible graft should be the first choice in the liver transplantation.However,emergency ABO-incompatible transplantation may be an effective and feasible method for patients with high preoperative MELD scores in the absence of ABO-compatible graft.