ABO Incompatible Liver Transplantation: Current Status

Living donor liver transplant (LDLT) is a predominant form of liver transplant in countries with scarce availability of cadaveric donors. In East and South Asian countries, more than 80% of liver transplants are LDLT. Breaching of ABO barrier has led to further expansion of donor pools in these countries and ABO-incompatible (ABOi) LDLT constitutes a significant number of living donor liver transplants. One of the most important steps in ABOi LDLT is pretransplant desensitization to prevent ABO antibodies-related rejection and graft dysfunction. Desensitization is achieved by preoperative rituximab and plasmapheresis. ABOi liver transplant has higher risk of AMR, non-anastomotic biliary strictures and sepsis. Improvement in immunosuppression and pretransplant desensitization protocols has led to comparable outcomes of graft and patient survival in ABOi liver transplant and ABO compatible (ABOc) liver transplant. Regular monitoring with liver biochemistry and imaging for graft function and vigilance for infectious complications are important for the prevention and management of complications in these patients.