Background: Rituximab prophylaxis and several total plasma exchanges are required for desensitization during the 2 weeks before ABO-incompatible living donor liver transplantation (ABOi-LDLT). There is still controversy regarding ABO-incompatible LDLT in acute liver failure or acute-on-chronic liver failure. Our study aims to compare the outcomes after ABOi-LDLT between emergent and elective groups.
Methods: Our center has performed 301 ABOi-LDLT cases between September 2010 and August 2023.
Result: Twenty-one patients (7.0%) underwent emergent ABOi-LDLT due to acute liver failure or acute-on-chronic liver failure. The male proportion in the emergent group was lower than in the elective group (42.9% vs. 75.4%; P=0.003). The median MELD score and the median time from rituximab prophylaxis to ABOi-LDLT were higher and shorter than in the elective group (29 vs. 11; P=0.003, 3 days vs. 18 days; P=0.001). The incidence of postoperative complications, infectious complications, and diffuse bile duct complications in the elective group were not different compared to those in the emergent group. The graft and overall survival in the emergent group were lower than in the elective group, but there were no statistically significant differences between the two groups.
Conclusion: There is no difference in postoperative outcomes between emergent ABOi LDLT through short-term desensitization and elective ABOi LDLT. Our study demonstrates that ABOi-LDLT is feasible even in emergent liver transplant patients.