ABO Incompatible Grafts Are Associated With Excellent Outcomes in Pediatric Liver Transplant Recipients: An Important Resource to Reduce Waitlist Mortality.

IF 1.4 4区医学 Q3 PEDIATRICS

Pediatric Transplantation Pub Date : 2025-05-01 DOI:10.1111/petr.70047

Pamela L Valentino, Patrick J Healey, James D Perkins, Biren Desai, Hugo Quezada, Niviann M Blondet, André A S Dick, Idoia Gimferrer, Simon P Horslen, Evelyn K Hsu, Yong K Kwon, Katelyn M Saarela, Mark L Sturdevant, Danielle Wendel, Jorge D Reyes

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引用次数: 0

Abstract

Background: Liver transplant (LT) waitlist mortality occurs in 10% of children; innovative strategies to expand access to LT can be lifesaving.

Methods: Outcomes of ABO incompatible (ABOi) LT performed between 1999 and 2023 at a high-volume center were compared to ABO compatible (ABOc) LT.

Results: 25 ABOi LT were performed among 270 LT; 72% were listed with status 1/1A/1B or a median pediatric end-stage liver disease/model for end-stage liver disease of 40 (IQR 32,41). Time on the waitlist for ABOi recipients was shorter (median 11 days [IQR 4,46]) compared to ABOc (113 days [IQR 39,252], p < 0.001). ABOi graft types were 64% technical variants (including 2 living donor grafts) and 36% whole; 52% received a duct-duct biliary anastomosis. There were no statistically significant differences in 1/5/10-year patient survival [ABOi: 87,87,87% vs. ABOc: 96,94,89%, p = 0.6] or graft survival [ABOi: 87,82,82% vs. ABOc: 92,86,80%, p = 0.9]. When compared to ABOc, there were no statistically significant differences in vascular complications, bile leaks, or acute T-cell-mediated rejection with ABOi LT. Biliary strictures were diagnosed in 43% of ABOi LT and more frequently than in ABOc (20%, p = 0.0495).

Conclusions: ABOi LT can offer children on the waitlist a survival advantage through shorter waiting time. ABOi LT can be performed safely with a low rate of vascular complications similar to ABOc LT.

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ABO不相容移植物与儿童肝移植受者的良好预后相关：减少等候名单死亡率的重要资源。

背景：肝移植（LT）等待名单死亡率为10%的儿童；扩大LT获取的创新战略可以挽救生命。方法：1999年至2023年在大容量中心进行ABO不相容（ABOi） LT与ABO相容（ABOc） LT的结果进行比较。结果：270例LT中有25例进行了ABOi LT；72%的患者的状态为1/1A/1B或儿童终末期肝病/终末期肝病模型的中位值为40 （IQR 32,41）。与ABOc（113天[IQR 39,252]）相比，ABOi接受者在等待名单上的时间更短（中位数为11天[IQR 4,46]）。结论：ABOi LT可以通过更短的等待时间为等待名单上的儿童提供生存优势。与ABOc肝移植类似，ABOi肝移植可以安全进行，血管并发症发生率低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Transplantation 医学-小儿科

CiteScore

2.90

自引率

15.40%

发文量

216

审稿时长

3-8 weeks

期刊介绍： The aim of Pediatric Transplantation is to publish original articles of the highest quality on clinical experience and basic research in transplantation of tissues and solid organs in infants, children and adolescents. The journal seeks to disseminate the latest information widely to all individuals involved in kidney, liver, heart, lung, intestine and stem cell (bone-marrow) transplantation. In addition, the journal publishes focused reviews on topics relevant to pediatric transplantation as well as timely editorial comment on controversial issues.