Korean J Transplant.  2022 Nov;36(Supple 1):S177. 10.4285/ATW2022.F-3034.

Impact of baseline anti-ABO antibody titer on biliary complications following ABO-incompatible living donor liver transplantation

• Jo HS
• Yu YD
• Park PJ
• Han HJ
• Kim WJ
• Kim SJ
• Kim DS

• KMID: 2535693
• DOI: http://doi.org/10.4285/ATW2022.F-3034

Abstract

Background
ABO-incompatible living donor liver transplantation (LDLT) has been increasingly performed in the shortage of ABO-compatible live and deceased donors. Although vigorous efforts to overcome immunologic hurdles, a higher biliary com-plication rate remains a critical issue to be solved. This study evaluated the impact of baseline anti-ABO antibody titer on biliary complications following ABO-incompatible LDLT.
Methods
Consecutive patients who underwent adult-to-adult LDLT were enrolled in this study. The study cohort comprised 126 patients in the ABO-compatible group, 16 in the low anti-ABO antibody titer (<1:64) group, and 23 in the high anti-ABO antibody ti-ter (1:64 or higher) group. Rituximab (300 mg/m ² ) was administered 2 weeks before surgery, and total plasma exchange was performed according to the anti-ABO antibody titer from 1 week before surgery. The target anti-ABO antibody titer was 1:8 or less.
Results
Postoperative biliary complications frequently developed in the ABOi-high titer group (9 [39.1%]) compared to the ABOi-low titer group and ABOc group (3 [18.8%] and 19 [15.1%], P=0.026). The number of bile duct openings and hepaticojeju-nostomy were not different between the three groups. High anti-ABO antibody titer (1:64 or higher) and male sex were indepen-dent risk factors for biliary complication (odds ratio, 4.14 [1.16–14.8], P=0.029 and 6.28 [1.35–29.3], P=0.019, respectively). In the long-term outcome, the patient and graft survival rates were not different between the groups.
Conclusions
Although anti-ABO antibody titer just before the LDLT is lowered, the higher baseline titer is an important factor for developing postoperative biliary complications. We should pay particular attention to bile duct anastomosis and postoperative care for patients with higher baseline titer.