ABO
Incompatible Deceased Donor Liver Transplants in Infants (Age < 1 Year): A Single‐Center Experience
Heli Bhatt, Sarah Kizilbash, Claudia Cohn, Oyedele Adeyi, Daniel Waller, David M. Vock, Gwenyth Fischer, Joseph Resch, Andrew Adams, Srinath Chinnakotla ABSTRACT
Background
The liver transplant waitlist mortality for infants (age < 1 year) is currently the highest, listed at 20 per 100 years of waiting time. ABO incompatible (ABOi) liver‐transplantation is one of the strategies to increase transplantation rate in infants but utilized only in 5.6% of infants.
Methods
At our center, all children < 1 year are listed for ABOi liver transplants. If the anti‐ABO titers are less than 1:8, no plasmapheresis was used. Thymoglobulin is used for induction. We analyzed the transplant outcomes of patients that received ABOi livers compared to ABOc livers.
Results
Sixteen infants, who received ABOi liver‐transplants are compared to 56 ABO‐compatible (ABOc) infant liver transplants. ABOi group utilized AB or B blood type livers 81%, compared to none in the ABOc group. The 1‐, 5‐, and 10‐year survival in the ABOi group remains at 81% and is comparable to survival in the ABOc group. None of the ABOi patients developed antibody‐mediated rejection or intrahepatic biliary strictures. None of the ABOi patients had hepatic artery thrombosis, compared with 4 (7.1%) in the ABOc group ( p = 0.64). There is no difference in infectious complications. The median wait times for patients < 1 year for blood types A, B, AB, and were 96, 109, 82 days and 126 respectively. The patients listed to accept ABOi livers had a shorter waiting time ( p = < 0.001).
Conclusions
This study shows that ABOi liver transplants can be safely performed in children less than1 year of age without plasmapheresis, with excellent long‐term outcomes.