ABO Incompatible Liver Transplantation in Children: A 20 Year Experience from Centres in the TransplantChild European Reference Network.

Małgorzata Markiewicz-Kijewska,Marco Spada,Daniela Liccardo,Eduardo Lopez-Granados,Carl Jorns,Sandra Ferreira,Grzegorz Kowalewski,Alastair Baker,On Behalf Of Ern Transplantchild Healthcare Working Group ,Diana Kamińska,Andrea Pietrobattista,Maria-Sole Basso,Maria Francelina Lopes,Ulrich Baumann,Juan Torres Canizales,Paloma Jara Vega,Piotr Kaliciński,Esteban Frauca Remacha,Angelo Di Giorgio

doi:10.3390/children8090760

Abstract

An increasing number of AB0-incompatible (AB0i) liver transplantations (LT) are being undertaken internationally in recent years due to organ shortages and the need for urgent transplantation. The aim of our study was establish the value of ABOi LT from available retrospective results of AB0i pediatric liver transplantations performed in European reference centers now belonging to the TransplantChild, European Reference Network (ERN). Data from medical records were analyzed, including demographic data, diagnosis, urgency of transplantation, time on the waiting list, PELD/MELD score, desensitization procedures, immunosuppression, selected post-transplant complications, and patient and graft survival. A total of 142 patients (pts) with transplants between 1986 and 2018 in 8 European transplant centers were included in the study. The indications for liver transplantation were: cholestatic diseases in 62 pts, acute liver failure in 42 pts, and other conditions in the remaining 38 pts. Sixty-six patients received grafts from living donors, and seventy-six received grafts from deceased donors. Both patient and graft survival were significantly affected by deceased donor type, urgent transplantation, and the development of vascular complications. In the multivariate analysis, vascular complications had a negative impact on patient and graft survival, while a longer time from the first AB0i LT in the study showed better results, suggesting an international learning experience. In conclusion, we believe that AB0i LT in children is now a safe procedure that may be adopted more readily in children.

Highlights

For more than 30 years, liver transplantation (LT) has been accepted as a major life-saving yet routine treatment for children with end-stage liver disease. This highly successful situation has led to an international situation of organ shortages that is especially critical for patients needing urgent transplantation
We found that the pre-transplant desensitization of children before AB0i LT was very uncommon in European centers, with high-dose intravenous immunoglobulins (IVIG) being given more often than alternatives but only in 8% of recipients
We showed that graft loss and recipient death were only related to two independent risk factors: vascular complications and time from first transplant, supporting the view that immunological reactions do not have a major influence on the results of AB0i LT in our particular pediatric populations

Summary

Introduction

For more than 30 years, liver transplantation (LT) has been accepted as a major life-saving yet routine treatment for children with end-stage liver disease. This highly successful situation has led to an international situation of organ shortages that is especially critical for patients needing urgent transplantation. Various desensitization protocols including splenectomy, high doses of immunoglobulins (1–2 g/kg body mass), plasmapheresis, immunoadsorption, rituximab, and basiliximab as single or combined treatment were introduced to protect AB0i grafts against humoral rejection: with varying success rates reported [1,2,3,4]

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