Stratified Analysis of Survival Benefit for ABO-incompatible Deceased-donor Liver Transplantation: Multicenter Propensity Score-matched Study

• Published in: Journal of clinical and translational hepatology 2023-08, Vol.11 (4), p.827-838
• Main Authors: Yang, Mengfan, Wei, Xuyong, Khan, Abdul Rehman, Wei, Qiang, Wang, Rui, Pan, Binhua, Wang, Kun, Zhou, Zhisheng, Lu, Di, Cen, Beini, Zhang, Shuijun, Guo, Wenzhi, Zheng, Shusen, Yang, Yang, Xu, Xiao
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2225-0719; 2310-8819
• DOI: 10.14218/JCTH.2022.00297

Liver transplantation (LT) using ABO-incompatible (ABOi) grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation. However, concerns of the impending prognosis associated with this option, especially for patients with liver failure and higher model for end-stage liver disease (MELD) scores, who tend to be more fragile during the waiting period before LT. Recipients undergoing LT for acute-on-chronic liver failure or acute liver failure were retrospectively enrolled at four institutions. Overall survival was compared and a Cox regression analysis was performed. Propensity score matching was performed for further comparison. Patients were stratified by MELD score and cold ischemia time (CIT) to determine the subgroups with survival benefits. Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible (ABOc) LT were enrolled. The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching (50.6% vs. 75.7%, 0.05). Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores ≥40 ( >0.05). For patients with MELD scores of 31-39, the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group (