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

초록

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 complication 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 (<1:128) group, and 23 in the high anti-ABO antibody titer (≥1:128) group. Rituximab (300mg/m2 ) 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 hepaticojejunostomy were not different between the three groups. High anti-ABO antibody titer (≥1:128) and male sex were independent risk factors for biliary complication (Odds ratio 3.15 [1.43–6.96], P=0.004 and 3.26 [0.98–10.81], P=0.054, respectively). In the long-term outcome, the overall survival rates were not different between the groups (P=0.205). Conclusions: Although anti-ABO antibody titer just before the LDLT was lowered through the desensitization protocol, the higher baseline titer was the most 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.