Abstracts of the 2025 Annual Meeting of the ALEH
More infoThe utilization of ABO-incompatible organs in deceased donor liver transplantation (ABOi-DDLT) has increased with the implementation of desensitization protocols, yielding comparable outcomes to ABO-compatible (ABOc) LT. However, there are no reports from Latin America, a region facing low donation rates, restricted resources and limited access to living donor LT.
To evaluate the feasibility and safety of ABOi-DDLT as a therapeutic strategy in emergency settings.
Materials and MethodsRetrospective study of DDLT recipients for acute liver failure, ≥12 years of age, between 2009-2024, in a liver transplantation center. Clinical characteristics, complications and survival outcomes were analyzed.
ResultsEight DDLT were performed (3 ABOi, 5 ABOc), 87.5% were female. Underlying etiologies were Wilson’s disease(n=6) and drug-induced liver injury(n=2). The ABOi group presented higher clinical severity (MELD-Na: 37 vs. 27). ABOi-DDLT desensitization included plasmapheresis(n=3) and rituximab(n=2), plus immunosuppression with basiliximab(n=3), tacrolimus(n=3), mycophenolate(n=2) and steroids(n=3). Pre-ABOi-DDLT isoagglutinins titers were quantified in 2 cases (anti-A/B: 1:64 and 1:8), with post-transplantation peaks (anti-A/B: 1:128) managed conservatively. One ABOi-patient developed antibody-mediated rejection, effectively treated with plasmapheresis and intravenous immunoglobulin. Biliary strictures occurred earlier in ABOi-patients (4 vs. 20 months). Rates of bacterial and viral infections were similar, whereas fungal infections were observed only in ABOc-recipients. One- and three-year survival was 100% in both groups; five-year survival was 100% in ABOi and 66.6% in ABOc recipients.
ConclusionsABOi-DDLT is a reliable and effective alternative. This study may serve as a foundation for a multicenter study led by ALEH aiming to further explore the issue across the region.
