Korean J Transplant.  2022 Nov;36(Supple 1):S259. 10.4285/ATW2022.F-4028.

Initial high anti-ABO isoagglutinin titer is a major red flag of bacterial infection in ABO-incompatible living donor liver transplantation

• Choi MC
• Min EK
• Yim SH
• Kim DG
• Lee JG
• Joo DJ
• Kim MS

• KMID: 2535476
• DOI: http://doi.org/10.4285/ATW2022.F-4028

Abstract

Background
Many previous studies showed comparable clinical outcomes of ABO-incompatible (ABOi) living donor liver trans-plantation (LDLT) compared to ABO-compatible (ABOc) LDLT, but there were few studies related to initial high anti-ABO isoagglu-tinin titer.
Methods
From January 2012 to March 2022, a total of 1,108 liver transplantations were performed at Severance Hospital. In ABOi LDLT, we compared initial high-anti-ABO and low-anti-ABO isoagglutinin (IA) titer groups based on a cutoff value of 1:256. The simplified desensitization protocol for ABOi LDLT consisted of plasma exchange and rituximab (375 mg/m 2 body surface area) aiming at maintaining levels of anti-ABO IA titers below 1:32.
Results
The initial low-IA titer ABOi LDLT group (immunoglobulin M [IgM] and IgG, <1:256) consisted of 142 patients and the initial high-IA titer ABOi LDLT group (IgM or IgG, 1:256) consisted of 59 patients. Additionally, the ABOc LDLT group consisted of 577 patients. Bacterial infection rates were 19.1% in ABOc LDLT group, 25.4% in the initial low-IA titer ABOi LDLT group, and 37.3% in the initial high-IA titer ABOi LDLT group, and the initial high-IA titer ABOi LDLT group had a significantly higher rate of bacterial infection than the other two groups (P=0.003). The initial high-IA titer ABOi LDLT group had a significant higher rate of bacterial sepsis and bacterial pneumonia than the other two groups (P=0.031 and P=0.021, respectively). In terms of infec-tion-related mortality, the initial high-IA titer ABOi LDLT group had a higher rate of 18.6% than 8.5% in the initial low-IA titer ABOi LDLT group and 4.7% in ABOc LDLT group (P=0.001).
Conclusions
ABOi LDLT is more prone to infectious complications than ABOc LDLT. Among ABOi LDLTs, recipients with an ini-tial high-IA titer are more susceptible to bacterial infection, sepsis, and bacterial pneumonia, along with reducing overall survival rate.