Outcome of ABO-incompatible adult living-donor liver transplantation for patients with hepatocellular carcinoma

Young In Yoon, Gi Won Song, Sung Gyu Lee, Shin Hwang, Ki Hun Kim, Seok Hwan Kim, Woo Hyoung Kang, Hwui Dong Cho, Eun Kyoung Jwa, Jae Hyun Kwon, Eun Young Tak, Varvara A. Kirchner

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background & Aims: Living-donor liver transplantation (LDLT) can simultaneously cure hepatocellular carcinoma (HCC) and underlying liver cirrhosis, improving long-term results in patients with HCC. ABO-incompatible LDLT could expand the living-donor pool, reduce waiting times for deceased-donor liver transplantation, and improve long-term survival for some patients with HCC. Methods: We retrospectively reviewed the medical records of patients undergoing LDLT for HCC from November 2008 to December 2015 at a single institution in Korea. In total, 165 patients underwent ABO-incompatible and 753 patients underwent ABO-compatible LDLT for HCC. ABO-incompatible recipients underwent desensitization to overcome the ABO blood group barrier, including pretransplant plasma exchange and rituximab administration (300–375 mg/m 2 /body surface area). Results: We performed 1:1 propensity score matching and included 165 patients in each group. 82.4% of ABO-incompatible and 83.0% of -compatible LDLT groups had HCC within conventional Milan criteria, respectively, and 92.1% and 92.7% of patients in each group had a Child-Pugh score of A or B. ABO-incompatible and -compatible LDLT groups were followed up for 48.0 and 48.7 months, respectively, with both groups showing comparable recurrence-free survival rates (hazard ratio [HR] 1.14; 95% CI 0.68–1.90; p = 0.630) and overall patient-survival outcomes (HR 1.10; 95% CI 0.60–2.00; p = 0.763). Conclusions: These findings suggested that ABO-incompatible liver transplantation is a feasible option for patients with HCC, especially for those with compensated cirrhosis with HCC within conventional Milan criteria. Lay summary: Despite hypothetical immunological concerns that the desensitization protocol for breaking through the ABO blood group barrier might have a negative impact on the recurrence of hepatocellular carcinoma, our experience demonstrated no significant differences in the long-term overall survival and recurrence-free survival rates between patients receiving ABO-compatible or ABO-incompatible liver transplantation. In conclusion, results from our institution indicated that ABO-incompatible living-donor liver transplantation constitutes a potentially feasible option for patients with hepatocellular carcinoma, especially those with compensated cirrhosis with hepatocellular carcinoma within conventional Milan criteria.

Original languageEnglish (US)
Pages (from-to)1153-1162
Number of pages10
JournalJournal of Hepatology
Issue number6
StatePublished - Jun 2018

Bibliographical note

Funding Information:
This research was partially supported by research funds from the Asan Institute for Life Sciences ( Tak EY, 15-662 ) and the National Research Foundation of Korea ( NRF-2015K1A4A3046807 ).

Publisher Copyright:
© 2018 European Association for the Study of the Liver


  • Liver transplantation
  • blood grouping and crossmatching
  • hepatocellular carcinoma


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