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
{"title":"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。","authors":"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","doi":"10.1111/petr.70047","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Liver transplant (LT) waitlist mortality occurs in 10% of children; innovative strategies to expand access to LT can be lifesaving.</p><p><strong>Methods: </strong>Outcomes of ABO incompatible (ABOi) LT performed between 1999 and 2023 at a high-volume center were compared to ABO compatible (ABOc) LT.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"29 3","pages":"e70047"},"PeriodicalIF":1.4000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"ABO Incompatible Grafts Are Associated With Excellent Outcomes in Pediatric Liver Transplant Recipients: An Important Resource to Reduce Waitlist Mortality.\",\"authors\":\"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\",\"doi\":\"10.1111/petr.70047\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Liver transplant (LT) waitlist mortality occurs in 10% of children; innovative strategies to expand access to LT can be lifesaving.</p><p><strong>Methods: </strong>Outcomes of ABO incompatible (ABOi) LT performed between 1999 and 2023 at a high-volume center were compared to ABO compatible (ABOc) LT.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":20038,\"journal\":{\"name\":\"Pediatric Transplantation\",\"volume\":\"29 3\",\"pages\":\"e70047\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Transplantation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/petr.70047\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Transplantation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/petr.70047","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PEDIATRICS","Score":null,"Total":0}
ABO Incompatible Grafts Are Associated With Excellent Outcomes in Pediatric Liver Transplant Recipients: An Important Resource to Reduce Waitlist Mortality.
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.
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.
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