Pediatric Liver Transplantation Across the ABO Blood Group Barrier: Is It an Obstacle in the Modern Era?

Abbas Rana, Michael Kueht, Sarah K. Nicholas, Peter T. Jindra, Ryan W. Himes, Moreshwar S. Desai, Ronald T. Cotton, N. Thao N. Galvan, Christine A. O'Mahony, John A. Goss

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background The initial experience with ABO incompatible (ABOi) orthotopic liver transplantations (OLTs) was dismal. In the current study, we investigated whether ABOi pediatric OLTs could achieve acceptable patient outcomes. The option for ABOi transplantation is vital because critically ill children have limited access to donor liver allografts. Study Design Kaplan-Meier and multivariate Cox analysis was performed on data collected from 13,179 pediatric OLT recipients in the United Network for Organ Sharing database, including 540 ABOi recipients. We also analyzed 18 pediatric recipients of ABOi OLTs at Texas Children's Hospital. Recipients were divided into 2 groups: transplanted between 1987 to 2002 (remote era) and 2002 to 2013 (modern era). Results Analysis revealed 4 main points. First, there was a significant (p < 0.01) improvement in ABOi OLT survival in the modern era. Second, threshold analysis revealed superior outcomes (p < 0.01) for OLT recipients younger than 2 years of age. Third, survival outcomes for ABOi and ABO-identical OLTs were the same for recipients younger than 2 years: ABOi was 91.8% (1 year) and 88.4% (5 year), and ABO identical was 91.5% (1 year) and 86.7% (5 year) (p = 0.94). Lastly, we found identical OLT results when analyzing our own institutional experience. To date, there has been a 92.9% survival rate in the modern era compared with 75% in the remote era. All recipients younger than 2 years (n = 9) are still alive, compared with 78% of those older than 2 years. Conclusions This analysis revealed a significant improvement in the survival of ABOi liver transplant recipients in the modern era. Importantly, ABOi liver transplantation can be performed in recipients younger than 2 years of age with equivalent outcomes compared with ABO-identical recipients.

Original languageEnglish (US)
Pages (from-to)681-689
Number of pages9
JournalJournal of the American College of Surgeons
Volume222
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Fingerprint

Blood Group Antigens
Liver Transplantation
Pediatrics
Survival
Liver
Critical Illness
Allografts
Multivariate Analysis
Survival Rate
Transplantation
Tissue Donors
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Pediatric Liver Transplantation Across the ABO Blood Group Barrier : Is It an Obstacle in the Modern Era? / Rana, Abbas; Kueht, Michael; Nicholas, Sarah K.; Jindra, Peter T.; Himes, Ryan W.; Desai, Moreshwar S.; Cotton, Ronald T.; Galvan, N. Thao N.; O'Mahony, Christine A.; Goss, John A.

In: Journal of the American College of Surgeons, Vol. 222, No. 4, 01.04.2016, p. 681-689.

Research output: Contribution to journalArticle

Rana, A, Kueht, M, Nicholas, SK, Jindra, PT, Himes, RW, Desai, MS, Cotton, RT, Galvan, NTN, O'Mahony, CA & Goss, JA 2016, 'Pediatric Liver Transplantation Across the ABO Blood Group Barrier: Is It an Obstacle in the Modern Era?', Journal of the American College of Surgeons, vol. 222, no. 4, pp. 681-689. https://doi.org/10.1016/j.jamcollsurg.2015.12.041
Rana, Abbas ; Kueht, Michael ; Nicholas, Sarah K. ; Jindra, Peter T. ; Himes, Ryan W. ; Desai, Moreshwar S. ; Cotton, Ronald T. ; Galvan, N. Thao N. ; O'Mahony, Christine A. ; Goss, John A. / Pediatric Liver Transplantation Across the ABO Blood Group Barrier : Is It an Obstacle in the Modern Era?. In: Journal of the American College of Surgeons. 2016 ; Vol. 222, No. 4. pp. 681-689.
@article{f3de3a1bc305417eba4c58a15f072019,
title = "Pediatric Liver Transplantation Across the ABO Blood Group Barrier: Is It an Obstacle in the Modern Era?",
abstract = "Background The initial experience with ABO incompatible (ABOi) orthotopic liver transplantations (OLTs) was dismal. In the current study, we investigated whether ABOi pediatric OLTs could achieve acceptable patient outcomes. The option for ABOi transplantation is vital because critically ill children have limited access to donor liver allografts. Study Design Kaplan-Meier and multivariate Cox analysis was performed on data collected from 13,179 pediatric OLT recipients in the United Network for Organ Sharing database, including 540 ABOi recipients. We also analyzed 18 pediatric recipients of ABOi OLTs at Texas Children's Hospital. Recipients were divided into 2 groups: transplanted between 1987 to 2002 (remote era) and 2002 to 2013 (modern era). Results Analysis revealed 4 main points. First, there was a significant (p < 0.01) improvement in ABOi OLT survival in the modern era. Second, threshold analysis revealed superior outcomes (p < 0.01) for OLT recipients younger than 2 years of age. Third, survival outcomes for ABOi and ABO-identical OLTs were the same for recipients younger than 2 years: ABOi was 91.8{\%} (1 year) and 88.4{\%} (5 year), and ABO identical was 91.5{\%} (1 year) and 86.7{\%} (5 year) (p = 0.94). Lastly, we found identical OLT results when analyzing our own institutional experience. To date, there has been a 92.9{\%} survival rate in the modern era compared with 75{\%} in the remote era. All recipients younger than 2 years (n = 9) are still alive, compared with 78{\%} of those older than 2 years. Conclusions This analysis revealed a significant improvement in the survival of ABOi liver transplant recipients in the modern era. Importantly, ABOi liver transplantation can be performed in recipients younger than 2 years of age with equivalent outcomes compared with ABO-identical recipients.",
author = "Abbas Rana and Michael Kueht and Nicholas, {Sarah K.} and Jindra, {Peter T.} and Himes, {Ryan W.} and Desai, {Moreshwar S.} and Cotton, {Ronald T.} and Galvan, {N. Thao N.} and O'Mahony, {Christine A.} and Goss, {John A.}",
year = "2016",
month = "4",
day = "1",
doi = "10.1016/j.jamcollsurg.2015.12.041",
language = "English (US)",
volume = "222",
pages = "681--689",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "4",

}

TY - JOUR

T1 - Pediatric Liver Transplantation Across the ABO Blood Group Barrier

T2 - Is It an Obstacle in the Modern Era?

AU - Rana, Abbas

AU - Kueht, Michael

AU - Nicholas, Sarah K.

AU - Jindra, Peter T.

AU - Himes, Ryan W.

AU - Desai, Moreshwar S.

AU - Cotton, Ronald T.

AU - Galvan, N. Thao N.

AU - O'Mahony, Christine A.

AU - Goss, John A.

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background The initial experience with ABO incompatible (ABOi) orthotopic liver transplantations (OLTs) was dismal. In the current study, we investigated whether ABOi pediatric OLTs could achieve acceptable patient outcomes. The option for ABOi transplantation is vital because critically ill children have limited access to donor liver allografts. Study Design Kaplan-Meier and multivariate Cox analysis was performed on data collected from 13,179 pediatric OLT recipients in the United Network for Organ Sharing database, including 540 ABOi recipients. We also analyzed 18 pediatric recipients of ABOi OLTs at Texas Children's Hospital. Recipients were divided into 2 groups: transplanted between 1987 to 2002 (remote era) and 2002 to 2013 (modern era). Results Analysis revealed 4 main points. First, there was a significant (p < 0.01) improvement in ABOi OLT survival in the modern era. Second, threshold analysis revealed superior outcomes (p < 0.01) for OLT recipients younger than 2 years of age. Third, survival outcomes for ABOi and ABO-identical OLTs were the same for recipients younger than 2 years: ABOi was 91.8% (1 year) and 88.4% (5 year), and ABO identical was 91.5% (1 year) and 86.7% (5 year) (p = 0.94). Lastly, we found identical OLT results when analyzing our own institutional experience. To date, there has been a 92.9% survival rate in the modern era compared with 75% in the remote era. All recipients younger than 2 years (n = 9) are still alive, compared with 78% of those older than 2 years. Conclusions This analysis revealed a significant improvement in the survival of ABOi liver transplant recipients in the modern era. Importantly, ABOi liver transplantation can be performed in recipients younger than 2 years of age with equivalent outcomes compared with ABO-identical recipients.

AB - Background The initial experience with ABO incompatible (ABOi) orthotopic liver transplantations (OLTs) was dismal. In the current study, we investigated whether ABOi pediatric OLTs could achieve acceptable patient outcomes. The option for ABOi transplantation is vital because critically ill children have limited access to donor liver allografts. Study Design Kaplan-Meier and multivariate Cox analysis was performed on data collected from 13,179 pediatric OLT recipients in the United Network for Organ Sharing database, including 540 ABOi recipients. We also analyzed 18 pediatric recipients of ABOi OLTs at Texas Children's Hospital. Recipients were divided into 2 groups: transplanted between 1987 to 2002 (remote era) and 2002 to 2013 (modern era). Results Analysis revealed 4 main points. First, there was a significant (p < 0.01) improvement in ABOi OLT survival in the modern era. Second, threshold analysis revealed superior outcomes (p < 0.01) for OLT recipients younger than 2 years of age. Third, survival outcomes for ABOi and ABO-identical OLTs were the same for recipients younger than 2 years: ABOi was 91.8% (1 year) and 88.4% (5 year), and ABO identical was 91.5% (1 year) and 86.7% (5 year) (p = 0.94). Lastly, we found identical OLT results when analyzing our own institutional experience. To date, there has been a 92.9% survival rate in the modern era compared with 75% in the remote era. All recipients younger than 2 years (n = 9) are still alive, compared with 78% of those older than 2 years. Conclusions This analysis revealed a significant improvement in the survival of ABOi liver transplant recipients in the modern era. Importantly, ABOi liver transplantation can be performed in recipients younger than 2 years of age with equivalent outcomes compared with ABO-identical recipients.

UR - http://www.scopus.com/inward/record.url?scp=84962361028&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84962361028&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2015.12.041

DO - 10.1016/j.jamcollsurg.2015.12.041

M3 - Article

C2 - 27016995

AN - SCOPUS:84962361028

VL - 222

SP - 681

EP - 689

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 4

ER -