J Korean Soc Transplant.  2012 Dec;26(4):277-286. 10.4285/jkstn.2012.26.4.277.

Analysis of Biliary Stricture after ABO Incompatible Adult Living Donor Liver Transplantation

• Yoon YI
• Song GW
• Lee SG
• Hwang S
• Ahn CS
• Kim KH
• Moon DB
• Ha TY
• Jung DH
• Park GC
• Namgung JM
• Park YH
• Park CS
• Park HW
• Kang SH
• Jung BH

• KMID: 2202431
• DOI: http://doi.org/10.4285/jkstn.2012.26.4.277

Abstract

BACKGROUND
Despite recent improvements in survival outcome after ABO incompatible (ABOi) adult living donor liver transplantation (ALDLT), concerns about the incidence of biliary stricture (BS) still exist. However, reports on the actual incidence of BS have been scarce.
METHODS
From November 2008 to August 2011, 77 cases of ABOi ALDLTs have been performed. We compared patient and graft survival and BS-free survival rates (BSFSR) between these ABOi ALDLTs and 734 ABO compatible (ABOc) ALDLTs performed during the same period. We also analyzed characteristics of BS in ABOi ALDLT.
RESULTS
There was one mortality (1.3%) and one re-transplantation (due to small-for-size graft syndrome) among 77 cases of ABOi ALDLTs. Overall, 1-, 2-, and 3-year patient survival rates were 94.8%, comparable to ABOc ALDLTs (93.7%, 90.1%, 90.1%, P=0.20). BS occurred in 11 (13.8%) ABOi ALDLT patients. There were no significant differences in 1-, 2-, and 3-year BSFSR between ABOi and ABOc ALDLT patients (87.5% vs. 88.1%, 83.4% vs. 87.5%, and 83.4% vs. 86.4%, P=0.55). Among 10 patients with BS, four patients showed diffuse multiple intrahepatic strictures, which were linked to the death of two patients.
CONCLUSIONS
The survival outcome of ABOi ALDLT is comparable to ABOc ALDLT. The incidence of BS of ABOi ALDLT was not superior to that of ABOc ALDLT. However, ABO incompatibility is related to the development of diffuse multiple intrahepatic BSs (rarely seen in ABOc ALDLT) and can cause graft failure and patient death.

Keyword

Blood group incompatibility; Bile duct stricture; Living donor liver transplantation

MeSH Terms

Adult
Blood Group Incompatibility
Constriction, Pathologic
Graft Survival
Humans
Incidence
Liver
Liver Transplantation
Living Donors
Survival Rate
Transplants

Figure

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  Fig. 1 Comparison of 1-, 2-, and 3-year patient (A) and graft (B) survival rates between ABO incompatible (ABOi) and ABO compatible (ABOc) adult living donor liver transplantations.

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  Fig. 2 Comparison of 1-, 2-, and 3-year biliary stricture-free survival rate between ABO incompatible (ABOi) and ABO compatible (ABOc) adult living donor liver transplantation. Abbreviation: BS, biliary stricture.

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  Fig. 3 Diffuse multiple intrahepatic biliary strictures in (A) case 7, (B) case 25, (C) case 29, and (D) case 34.

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