Outcomes after identical and compatible orthotopic liver transplantation for fulminant hepatic failure: a single center experience in UK

Abstract

Summary To analyze the outcomes between identical and compatible liver transplantation (OLT) for fulminant hepatic failure (FHF) from September 1984 to November 2005. The patients were divided in three groups; group 1 (identical), group 2 (compatible) and group 3 (incompatible), according to the donor‐recipient blood type matching. We analyzed several outcomes regarding mortality, patient and graft survival, incidence of acute graft rejection during the first postoperative month (30 days), incidence of biliary complications and indications of re‐transplantation. We also analyzed the relationship of Coomb's positive test with postoperative hemolysis to all the above mentioned factors. During the study period, 168 males and 112 females underwent their first OLT for FHF, with 37.1% overall mortality and 42.1% overall graft failure rate. The results between group 1 (203 patients) and group 2 (73 patients) were comparable. A statistically significant difference was recorded in 1 year and overall graft survival between group 1 and group 2 (P = 0.049 and log‐rank = 0.035 respectively). Coomb's positive test did not influence the outcomes. OLT in FHF can be safely carried out whether the donor organs are identical or compatible. Hemolysis (Coomb's positive test) after identical or compatible OLT does not influence the outcomes.

Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis

“…Studies that involved urgent indica-tions[ 15 , 17 , 19 , 20 , 33 , 34 , 39 , 40 , 42 ] had worse 1-year graft survival (OR = 0.37, 95%CI: 0.23-0.59 vs OR=0.70, 95%CI: 0.61-0.81; P = 0.01) but better 5-year patient survival (OR = 2.38, 95%CI: 0.86-6.63 vs OR = 0.79, 95%CI: 0.57-1.08, P = 0.043) for ABO-I LT than those for ABO-CT when compared to studies without urgent indications.…”

Role of Liver Transplantation in Acute Liver Failure

“…Some studies have reported no statistical difference in graft survival, while others have demonstrated that patient survival is less in ABOcompatible recipients compared to ABO-identical recipients. ABO-identical OLT is still preferred (Aladag et al, 2006;Bjoro et al, 2003;Koukoutsis et al, 2007); Smith et al, 2000).…”

Is ABO-Compatible but Non-Identical Intestinal Transplant Comparable to ABO-Identical Transplant? An Analysis of the UNOS Registry

“…Possibly due to the fact that kidney transplant contains fewer GVH antibodies and GVH antibody-producing cells, GVH antibody-induced hemolytic anemia was mild and does not cause serious consequences in kidney transplantation. In liver transplantation, with presumably more GVH antibodies or GVH antibody-producing cells, Koukoutisis [6] and Bjoro [7] reported that ABO-compatible transplant recipients have significantly lower graft and patient survival compared to ABO-identical transplant patients. The intestine possesses the largest mass of lymphoid tissue of any solid organ in the human body [15].…”