Chances and Risks in Living Donor Liver Transplantation: Blood-group Compatibility not Indispensable

by Dr. med. Jessica Walter, Prof. Dr. med. Martin Burdelski, and Prof. Dr. med. Dieter C. Bröring in issue No. 6, 2008

With regard to living-donor liver transplantation, it should be added that blood-group compatibility of the donor and the recipient, though always desirable, is not an absolute sine qua non. There have been many reports, mainly from Asia, of living-donor liver transplantation where the donor and the recipient had different blood types.

In the Göttingen Transplantation Center, three AB0-incompatible living-donor liver transplantations have been performed to date (report submitted for publication).

The data from Asia show a higher rate of biliary and vascular complications after such procedures (3), resulting in a lower rate of transplant survival. Under favorable conditions, however, a three-year patient survival of 70% can be achieved in adults, and 85% in children (1).

Intensive interdisciplinary collaboration and preparation of the recipient are essential for an optimal result of transplantation. Generally speaking, a special immunosuppression regimen is necessary, as well as a reduction of the serum titers of blood-group specific antibodies in the recipient. This can be achieved by plasmapheresis or by immunoadsorption (2, 3).
Because of the lower rates of transplant and patient survival associated with AB0-incompatible living-donor liver transplantation, it remains a treatment option to be pursued only in individual cases in the face of the persisting donor shortage.

The recent, promising advances in immune suppression and the ever-improving safety of liver donation surgery nonetheless justify the use of AB0-incompatible living-donor liver transplantation as a treatment option of last resort. DOI:10.3238/aerztebl.2008.0615b


Dr. med. Armin Goralczyk
Dr. med. Thomas Lorf
Clinic for General and Visceral Surgery
Universitätsmedizin Göttingen
D-37099 Göttingen
Germany
E-mail: [e-mail]
E-mail: [e-mail]

Priv.-Doz. Dr. med. Aiman Obed
Department of Surgery
Regensburg University Clinic
D-93053 Regensburg
Germany

References

1. Egawa H, Teramukai S, Haga H, Tanabe M, Fukushima M, Shimazu M: Present status of AB0-incompatible living donor liver transplantation in Japan. Hepatology 2008; 47: 11–3.

2. Donauer J, Wilpert J, Geyer M et al.: AB0-incompatible kidney transplantation using antigen-specific immunadsorption and rituximab: a singlie center experience. Xenotransplantation 2006; 13: 108–10.

3. Kozaki K, Egawa H, Ueda M, Oike F, Yoshizawa A, Fukatsu A, Takada Y: The role of apheresis therapy for AB0 imcompatible living donor liver transplantation: the Kyoto University experience. Therapeutic Apheresis and Dialysis 2006; 10: 441–8