Outcomes of Pediatric ABO-Incompatible Living Donor Liver Transplantation: A Retrospective Single-Centre Experience from India.

BACKGROUND/AIMS: ABO incompatible liver transplant (ABOi-LT) is an essential alternative to blood-group-compatible liver transplant (LT) in children, and there is limited experience with this, especially from the developing world. The current analysis focuses on our experience of ABOi-LT in children. METHOD: A retrospective analysis of all children undergoing ABOi-LT at our centre from January 2011 to February 2024 was performed. Their clinical profile, desensitisation protocol, post-transplant complications, patient and graft survival were analysed. RESULTS: We performed 35 (5%) ABOi-LTs during the above-mentioned time period. The median (interquartile range [IQR]) age at ABOi-LT was 15 (10-72) months, and the commonest aetiology was biliary atresia in 22 (63%) patients. Nineteen (54%) patients were below 18 months of age. Pre-LT plasmapheresis was offered to 24 (64%) patients, and 24 (64%) received rituximab. In children less than 18 months of age, 8 (42%) received pre-LT rituximab. None of the patients had major infections secondary to rituximab in the pre-LT period. Post-LT plasmapheresis was offered to 20 (57%) patients and 5 (15%) required immunoadsorption for persistently high antibody titres. Acute T-cell-mediated rejection was seen in 6 (17%) and 2 (5.5%) patients developed antibody-mediated rejection (AMR). No patients had hepatic artery thrombosis, anastomotic biliary strictures or bile leaks and 1 (2.7%) had chronic portal vein thrombosis. The median (IQR) duration of hospital stay was 16 (14-19.5) days. After a median follow-up of 24 months, overall survival was 34 (97%). Two patients with AMR were successfully treated and have normal graft function on follow-up. CONCLUSION: Excellent outcomes post-ABOi-LT can be achieved in children by using effective desensitisation protocols.