Clinical Retrospective Analysis Of ABO-incompatible Liver Transplantation On Type-O Patients

Objective:To investigate the efficacy and safety of ABO-i liver transplantation in patients with type O blood.Methods:A total of 103 O-type blood patients who underwent liver transplantation at the First Affiliated Hospital of Zhejiang University School of Medicine from January 1,2015 to December 31,2017 were included in the study.According to the matching of blood types,patients were divided into ABO-i group and ABO-c group,the general data of patients,the occxirrence of postoperative complications and the long-term survival of the recipients were compared between the two groups.The causes and the risk factors of death after ABO-i liver transplantation were retrospectively analyzed in this study.Results:The mean ages of ABO-i and ABO-c were 43.8±11.7 years and 50.1±10.1 years respectively,and the difference was statistically significant(P=0.008).The score in the Child-Pugh classification of ABO-i group was 10.8±.2.1,significantly higher than the ABO-c group of 8.7±2.3,P=0.000;there was no significant difference between the two groups of other general data(P<0.05).The cumulative survival rate of ABO-i group and ABO-c group were 66.6%(22/33)and 78.6%(55/70),the difference was not statistically significant(P?0.191);among the causes of postoperative death in ABO-i group,9 cases of septic shock and 3 cases of multiple organ failure,1 case of hepatocellular carcinoma recurrence and acute rejection respectively.The incidence of hepatic artery stenosis or thrombosis and diffuse biliary stricture in ABO-i group were 12.1%(4/33)and 15.2%(5/33),which was significantly higher than ABO-c group 1.4%(1/70)and 2.9%(2/70),the difference was statistically significant(P=0.018,P?0.021);there were no statistically significant differences in other postoperative complications between the two groups;Univariate analysis showed that intraoperative high infusion of red blood cells(P=0.016)and the incidence of postoperative hepatic artery stenosis or thrombosis(P=0.019),diffuse intrahepatic biliary stricture(P=0.015),Infection(P=0.043))were closely related to the death post ABO-i liver transplantation;multiple Cox regression analysis showed that intraoperative high infusion of red blood cells(P=0.106,RR?6.178)or hepatic artery stenosis and thrombosis(P=0.910,RR=1.129),diffuse intrahepatic biliary stenosis(P=0.4005 RR=2.077)or infection(P=0.495,RR=1.625)were not independent risk factors for death after ABO-i liver transplantation.Conclusion:O-type blood recipients received ABO-i liver transplantation has acquired favorable curative effect,and the cumulative survival rate may achieve the same effect as ABO-c liver transplantation.The occurrence of postoperative hepatic artery stenosis or thrombosis and diffuse intrahepatic biliaxy stricture of ABO-i liver transplantation was significantly higher than ABO-c liver transplantation;the most common cause of death after type-O recipients receiving ABO-i liver transplantation was septic shock;intraoperative high infusion of red blood cells,the incidence of hepatic artery stenosis or thrombosis,diffuse intrahepatic biliary stricture and infection were risk factors for death,but were not independent risk factors;ABO-i liver transplantation is an acceptable option to save type-O patient's life in emergency.