ABO incompatible liver transplant
ABO-incompatible (ABO-I) LDLT is an aggressive treatment & only chance for some patients that crosses the blood-typing barrier for saving lives from liver diseases, when ABO-compatible (ABO-C) donors are not available.
Humans have two major transplantation antigen systems – ABO and HLA system. In solid organ transplantation the ABO system is being considered as most important while the HLA system plays a minor role. Blood group antigens are expressed in almost every cell in the body, and an individual develops antibodies against blood group antigens (anti-A/B antibodies) absent in his or her own tissue. Grafts expressing foreign A/B antigens are usually hyperacutely rejected (antibody mediated rejection).
Although ABO-I liver transplantation is now feasible with preoperative desensitization with rituximab , plasmapheresis/plasma exchange, mycophenolate mofetil and intravenous immunoglobulin to reduce anti-A/anti-B isoagglutinin titers (<1:64) and to prevent antibody-mediated rejection .
Nowadays patient survival in ABO-I LDLT was comparable to that in ABO-C LDLT owing to various desensitization strategies. Therefore, considering the fact that cases of ABO-I LDLT would inevitably rise due to increased difficulty of matching appropriate ABO-C liver grafts.