ABO Incompatible Deceased Donor Liver Transplants in Infants (Age < 1 Year): A Single‐Center Experience

BACKGROUND: The liver transplant waitlist mortality for infants (age < 1 year) is currently the highest, listed at 20 per 100 years of waiting time. ABO incompatible (ABOi) liver-transplantation is one of the strategies to increase transplantation rate in infants but utilized only in 5.6% of infants. METHODS: At our center, all children < 1 year are listed for ABOi liver transplants. If the anti-ABO titers are less than 1:8, no plasmapheresis was used. Thymoglobulin is used for induction. We analyzed the transplant outcomes of patients that received ABOi livers compared to ABOc livers. RESULTS: Sixteen infants, who received ABOi liver-transplants are compared to 56 ABO-compatible (ABOc) infant liver transplants. ABOi group utilized AB or B blood type livers 81%, compared to none in the ABOc group. The 1-, 5-, and 10-year survival in the ABOi group remains at 81% and is comparable to survival in the ABOc group. None of the ABOi patients developed antibody-mediated rejection or intrahepatic biliary strictures. None of the ABOi patients had hepatic artery thrombosis, compared with 4 (7.1%) in the ABOc group (p = 0.64). There is no difference in infectious complications. The median wait times for patients < 1 year for blood types A, B, AB, and were 96, 109, 82 days and 126 respectively. The patients listed to accept ABOi livers had a shorter waiting time (p = < 0.001). CONCLUSIONS: This study shows that ABOi liver transplants can be safely performed in children less than1 year of age without plasmapheresis, with excellent long-term outcomes.