Therapeutic efficacy analysis of ABO incompatible liver transplantation for hepatocellular carcinoma / 中华器官移植杂志

ABSTRACT

Objective:To explore the efficacy and safety of ABO-incompatible (ABO-I) liver transplantation for hepatocellular carcinoma.Methods:Forty-four ABO-I liver transplantation recipients were matched with ABO-compatible (ABO-C) recipients by propensity score matching in a ratio of 1 2. The cumulative overall survival (OS) rate, disease-free survival (DFS) rate and complications were compared between two groups.Results:Compared with ABO-C group, the levels of serum creatinine (sCr) were significantly higher in ABO-I group at Days 7 and 14 post-operation (89.1±36.9 vs 74.8±26.2 umol/L, P=0.001; 77.9±27.6 vs 67.6±18.6 umol/L, P=0.002). The incidence of hepatic arterial thrombosis (9.1% vs 1.1%, P=0.024), biliary complications (25.0% vs 8.0%, P=0.007), early allograft dysfunction (52.3% vs 31.8%, P<0.001) and acute kidney injury(68.1% vs 36.4%, P<0.001) also significantly spiked in ABO-I group. The postoperative cumulative OS, DFS and graft survival rate of ABO-C group were significantly higher than those of ABO-I group ( P<0.001). No inter-group difference existed in survival rate or complication incidence in accordance with the Hangzhou criteria. However, OS, DFS and graft survival rates of ABO-I group were significantly lower than those of ABO-C group ( P<0.001) and the incidence of hepatic artery thrombosis (6.7% vs 0.0%, P=0.043), biliary complications (30.0% vs 6.7%, P=0.003), early allograft dysfunction (53.3% vs 28.3%, P=0.020) and acute kidney injury (63.3% vs 28.3%, P<0.001) significantly rose exceeding the Hangzhou criteria. Conclusions:ABO-I liver transplantation does not affect the OS rate, graft survival rate and postoperative complications in accordance with the Hangzhou criteria. For HCC recipients exceeding the Hangzhou criteria, the prognosis of ABO-I liver transplantation is significantly inferior to that of ABO-C liver transplantation. Careful implementations and accurate evaluations should be performed for ABO-I liver transplantation. Patients exceeding the Hangzhou criteria may receive down-staging treatment so as to obtain transplantation opportunities and yield a better prognosis.