THE USE OF ABO-INCOMPATIBLE GRAFTS IN LIVER-TRANSPLANTATION - A LIFESAVING PROCEDURE IN HIGHLY SELECTED PATIENTS

The aim of this study was to assess the long term results of 43 ABO-in compatible liver transplantations performed in 40 patients, The 5-year patient and graft survival rates were 50 and 20%, respectively. In th e group of patients transplanted in emergency for fulminant or subfulm inant liver failure, ABO incompatibility had no significant impact on patient survival (P=0.09). Graft survival, however, was significantly impaired (P=0.0002) through a greater incidence of hyperacute rejectio n (20%), vascular thrombosis, and biliary injury (56%), Increasing the magnitude of immunosuppression and postoperatively reducing the titer of anti A/B antibodies by plasmapheresis had little influence on the incidence of these complications and were associated with a greater in cidence of septic complications. These results indicate that the use o f ABO-incompatible liver grafts is a life-saving procedure in patients with life-threatening acute liver failure, but at a high price. Justi fication for accepting or not accepting an ABO-incompatible graft in t hese emergency situations depends on the personal choice in giving pri ority to saving the patient in an acute life-threatening condition or to giving the graft the best chance of success. To avoid this difficul t choice, efforts should aim at expanding the pool of grafts available in emergency, at developing artificial support devices that could all ow to safely delay transplantation, or at more efficiently controlling the humoral response.