Stratified Analysis of Survival Benefit for ABO-incompatible Deceased-donor Liver Transplantation: Multicenter Propensity Score-matched Study

Mengfan Yang; Xuyong Wei; Abdul Rehman Khan; Qiang Wei; Rui Wang; Binhua Pan; Kun Wang; Zhisheng Zhou; Di Lu; Beini Cen; Shuijun Zhang; Wenzhi Guo; Shusen Zheng; Yang Yang; Xiao Xu

doi:10.14218/JCTH.2022.00297

Stratified Analysis of Survival Benefit for ABO-incompatible Deceased-donor Liver Transplantation: Multicenter Propensity Score-matched Study

J Clin Transl Hepatol. 2023 Aug 28;11(4):827-838. doi: 10.14218/JCTH.2022.00297. Epub 2023 Feb 1.

Authors

Mengfan Yang^{1

2}, Xuyong Wei^{2

3}, Abdul Rehman Khan^{2

3}, Qiang Wei^{2

3}, Rui Wang^{2

4}, Binhua Pan^{2

3}, Kun Wang³, Zhisheng Zhou⁵, Di Lu^{2

3}, Beini Cen², Shuijun Zhang⁶, Wenzhi Guo⁶, Shusen Zheng^{4

5

7

8}, Yang Yang⁹, Xiao Xu^{2

4}

Affiliations

¹ Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, Shandong, China.
² Key Laboratory of Integrated Oncology and Intelligent Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
³ Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
⁴ Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
⁵ National Center for Healthcare Quality Management in Liver Transplant, Hangzhou, Zhejiang, China.
⁶ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, China.
⁷ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
⁸ Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, Zhejiang, China.
⁹ Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.

Abstract

Background and aims: Liver transplantation (LT) using ABO-incompatible (ABOi) grafts can extend the donor pool to a certain extent and hence reduce the waiting time for transplantation. However, concerns of the impending prognosis associated with this option, especially for patients with liver failure and higher model for end-stage liver disease (MELD) scores, who tend to be more fragile during the waiting period before LT.

Methods: Recipients undergoing LT for acute-on-chronic liver failure or acute liver failure were retrospectively enrolled at four institutions. Overall survival was compared and a Cox regression analysis was performed. Propensity score matching was performed for further comparison. Patients were stratified by MELD score and cold ischemia time (CIT) to determine the subgroups with survival benefits.

Results: Two hundred ten recipients who underwent ABOi LT and 1,829 who underwent ABO compatible (ABOc) LT were enrolled. The 5-year overall survival rate was significantly inferior in the ABOi group compared with the ABOc group after matching (50.6% vs. 75.7%, p<0.05). For patients with MELD scores ≤30, using ABOi grafts achieved a comparable overall survival rate as using ABOc grafts (p>0.05). Comparison of the survival rates revealed no statistically significant difference for patients with MELD scores ≥40 (p>0.05). For patients with MELD scores of 31-39, the overall survival rate was significantly inferior in the ABOi group compared with the ABOc group (p<0.001); however, the rate was increased when the liver graft CIT was<8 h.

Conclusions: For recipients with MELD scores ≤30, ABOi LT had a prognosis comparable to that of ABOc LT and can be regarded as a feasible option. For recipients with MELD scores ≥40, ABOi should be adopted with caution in emergency cases. For recipients with MELD scores of 31-39, the ABOi LT prognosis was worse. However, those patients benefited from receiving ABOi grafts with a CIT of <8 h.

Keywords: ABO-incompatible; Cold ischemia time; Liver transplantation; Model for end-stage liver disease score; Propensity score matching.