Backgrounds: Reports from several experienced centers suggested that outcomes of an ABO-incompatible (ABOi) living donor liver transplantation (LDLT) after rituximab and reduction of ABO antibodies showed a high success rate. However, there are few detailed comparative data regarding biliary complications, infectious episodes, and patient survival betwen ABO-compatible (ABOc) and ABOi LDLT. We compared the outcomes of ABOi LDLT with those of ABOc LDLT using matching method.

Methods: Forty-seven ABOi LDLT cases were performed between 2010 and 2013. Matched variables were the time of LDLT, Child-Pugh class, gender, age, model for end-stage liver disease (MELD) score, hepatic steatosis in living donor, liver graft, graft-recipient weight ratio (GRWR), and diagnosis. ABOc LDLT cases were selected according to matched variables (1:2 matching).

Results: Seventy-four patients in ABOc LDLT cases were selected as control group. The incidences of CMV infection, bacterial infection, and fungal infection at 3 months in between ABOi LDLT group and ABOc LDLT did not reach significant (81.1% vs 75.5%, 27.7% vs. 37.2%, and 12.8% vs. 20.2%, respectively). The incidence of acute rejection in ABOi LDLT was 12.8%. Antibody-mediated rejection was two cases in the early posttransplant period, but liver function in two cases were improved with plasmapheresis. There was no differences in acute rejection and biliary complications between ABOi and ABOc (P=0.478 and P=0.511, respectively). However, three cases in ABOi group developed non-bile duct anastomosis strictures, and these patients occurred to graft failure. The 1-year, 2-year, and 3-year patient survival rates in ABOi LDLT and ABOc LDLT were 89.3%, 85.0%, 85.0% and 87.2%, 83.3%, 78.75, respectively.

Conclusion: The outcomes of ABOi LDLT were similar to those of ABOc LDLT. ABOi LDLT should be considered in patients without suitable donor.

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