Impact of ABO incompatibility on adult deceased donor liver transplantation outcomes: A 20-year retrospective study using the SRTR database

IF 1.6 4区医学 Q4 IMMUNOLOGY

Transplant immunology Pub Date : 2026-08-20 DOI:10.1016/j.trim.2026.102444

Sukhdeep Jatana, Kevin Verhoeff, Zofia Czarnecka, A.M. James Shapiro, Khaled Dajani, Blaire Anderson, David L. Bigam

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引用次数: 0

Abstract

Background

ABO-incompatible (ABOi) deceased donor liver transplantation (DDLT) is seldom used due to concerns regarding postoperative outcomes, derived from predominantly older cohorts with small sample sizes. The aim of this study is to assess the impact of ABO incompatibility on outcomes of DDLT in a large, contemporary cohort.

Methods

Adult DDLT patients were included from the Scientific Registry of Transplant Recipients (SRTR) database who underwent transplant from 2004 to 2024. Demographics and complications were compared between ABOi and ABO-compatible (ABO-c) cohorts. Multivariate Cox proportional hazards models were generated to assess the impact of ABO incompatibility on 5-year outcomes.

Results

A total of 125,997 patients were included, with 1371 (1.1%) being ABOi. The ABOi cohort tended to be younger (53.0 ± 11.9vs54.5 ± 11.0,p < 0.001) but with severe disease requiring preoperative ICU care (24.4%vs14.1%,p < 0.001) and with higher MELD scores (25.6vs21.9,p < 0.001). Multivariate survival modelling showed that ABOi is not associated with graft loss (defined as mortality or retransplant; aHR 1.00, 95%CI 0.84–1.18) or mortality (aHR 0.83, 95%CI 0.68–1.01), but with increased likelihood of retransplant (aHR 2.08, 95%CI 1.42–3.06). Results were similar when A2 to O incompatible transplants were excluded.

Conclusions

ABOi DDLT is associated with increased likelihood of retransplant but did not show an association with mortality, supporting its use in highly selective unwell patients requiring urgent transplant.

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ABO血型不合对成人死亡供肝移植结果的影响：一项使用SRTR数据库的20年回顾性研究

背景abo血型不相容（ABOi）的死亡供体肝移植（DDLT）很少使用，因为考虑到术后结果，主要来自年龄较大的小样本量队列。本研究的目的是评估ABO不相容对当代大队列DDLT结果的影响。方法从2004年至2024年接受移植的SRTR数据库中纳入成人DDLT患者。比较ABOi组和abo相容组（ABO-c）的人口统计学特征和并发症。建立多变量Cox比例风险模型来评估ABO血型不合对5年预后的影响。结果共纳入125,997例患者，其中ABOi 1371例（1.1%）。ABOi群体倾向于更年轻(53.0 ±11.9 vs54.5 ± 11.0,p & lt; 0.001)但有严重疾病需要术前ICU护理(vs14.1% 24.4%, p & lt; 0.001)和更高的MELD分数(25.6 vs21.9 p & lt; 0.001)。多变量生存模型显示ABOi与移植物损失（定义为死亡率或再移植；aHR 1.00, 95%CI 0.84-1.18）或死亡率（aHR 0.83, 95%CI 0.68-1.01）无关，但与再移植可能性增加有关（aHR 2.08, 95%CI 1.42-3.06）。当排除A2和O不相容移植时，结果相似。结论：saboi DDLT与再次移植的可能性增加有关，但与死亡率无关，支持将其用于需要紧急移植的高度选择性不适患者。

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

Transplant immunology 医学-免疫学

CiteScore

2.10

自引率

13.30%

发文量

198

审稿时长

48 days

期刊介绍： Transplant Immunology will publish up-to-date information on all aspects of the broad field it encompasses. The journal will be directed at (basic) scientists, tissue typers, transplant physicians and surgeons, and research and data on all immunological aspects of organ-, tissue- and (haematopoietic) stem cell transplantation are of potential interest to the readers of Transplant Immunology. Original papers, Review articles and Hypotheses will be considered for publication and submitted manuscripts will be rapidly peer-reviewed and published. They will be judged on the basis of scientific merit, originality, timeliness and quality.