Outcomes Of ABO-incompatible Donation After Cardiac Death Liver Transplantation In Rituximab Era

Objective:This study aimed to evaluate the outcomes of ABO-incompatible donation after cardiac death (DCD) liver transplantation using rituximab prophylaxis.Methods:We retrospectively collected the data regarding adult tumor-free recipients who underwent donation after cardiac death liver transplantation at the First Affiliated Hospital, School of Medicine, Zhejiang University between April,2010 and December, 2014. The recipients were divided into two groups:ABO-incompatible (ABO-I) liver transplantation group and ABO-compatible (ABO-C) liver transplantation group. Post-operative complications, graft and patient survival were analyzed.Results:In total,59 ABO-I and 118 ABO-C liver transplants were included into the present study. Compared to ABO-C group, ABO-I grafts did not increase the incidence of post-operative complications. The 3-year graft survival rates of ABO-I and ABO-C groups were 89.3% and 95.5%, respectively. No significant difference was noted (P= 0.111). The 1-,3-and 5-year patient survival rates were 79.7%,65.3% and 65.3% in ABO-I group, and 89.8%,83.0% and 83.0% in ABO-C group. Statistical significance regarding the difference was observed (P= 0.011). Septic and hemorrhagic multiple organ failure (MOF) were the two predominant post-operative death causes, and higher incidence of septic MOF was identified in ABO-I group (16.9% vs.4.2%, P= 0.004).Conclusion:The rituximab significantly reduced the incidence of post-operative complications and graft failure, while increased the prevalence of life-threatening infections resulting in limited improvement of patient survival in ABO-I liver transplantation. Therefore, ABO-C graft should be the first choice for DCD liver transplantation, but ABO-I livers can still be life-saving under emergency circumstances in rituximab era.