Meta-Analysis
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6516-6533
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6516
Outcomes after liver transplantation in accordance with ABO compatibility: A systematic review and meta-analysis
Eung Chang Lee, Seong Hoon Kim, Sang-Jae Park
Eung Chang Lee, Seong Hoon Kim, Sang-Jae Park, Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do 410-769, South Korea
Author contributions: Lee EC, Kim SH, Park SJ designed the research; Lee EC performed the research and wrote the paper; Kim SH supervised the study and revised the paper.
Conflict-of-interest statement: No conflicts of interest were declared for all authors.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at kshlj@ncc.re.kr. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seong Hoon Kim, MD, PhD, Center for Liver Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, South Korea. kshlj@ncc.re.kr
Telephone: +82-31-9201647 Fax: +82-31-9201138
Received: May 26, 2017
Peer-review started: May 26, 2017
First decision: June 23, 2017
Revised: July 7, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: September 21, 2017
Processing time: 118 Days and 5.9 Hours
Abstract
AIM

To evaluate the differences in outcomes between ABO-incompatible (ABO-I) liver transplantation (LT) and ABO-compatible (ABO-C) LT.

METHODS

A systematic review and meta-analysis were performed by searching eligible articles published before No-vember 28, 2016 on MEDLINE (PubMed), EMBASE, and Cochrane databases. The primary endpoints were graft survival, patient survival, and ABO-I-related complications.

RESULTS

Twenty-one retrospective observational studies with a total of 8247 patients were included in this meta-analysis. Pooled results of patient survival for ABO-I LT were comparable to those for ABO-C LT. However, ABO-I LT showed a poorer graft survival than ABO-C LT (1-year: OR = 0.66, 95%CI: 0.57-0.76, P < 0.001; 3-year: OR = 0.74, 95% CI 0.64-0.85, P < 0.001; 5-yearr: OR =0.75, 95%CI: 0.66-0.86, P < 0.001). Furthermore, ABO-I LT was associated with more incidences of antibody-mediated rejection (OR = 74.21, 95%CI: 16.32- 337.45, P < 0.001), chronic rejection (OR =2.28, 95%CI: 1.00-5.22, P = 0.05), cytomegalovirus infection (OR = 2.64, 95%CI: 1.63-4.29, P < 0.001), overall biliary complication (OR = 1.52, 95%CI: 1.01-2.28, P = 0.04), and hepatic artery complication (OR = 4.17, 95%CI: 2.26-7.67, P < 0.001) than ABO-C LT. In subgroup analyses, ABO-I LT and ABO-C LT showed a comparable graft survival in pediatric patients and those using rituximab, and ABO-I LT showed an increased acute cellular rejection in cases involving deceased donor grafts.

CONCLUSION

Although patient survival in ABO-I LT was comparable to that in ABO-C LT, ABO-I LT was inferior to ABO-C LT in graft survival and several complications. Graft survival of ABO-I LT could be comparable to that of ABO-C LT in pediatric patients and those using rituximab.

Keywords: ABO-incompatibility; Liver transplantation; Graft survival; Patient survival; Complications

Core tip: This meta-analysis analyzed more than 8000 cases of ABO-incompatible (ABO-I) and ABO-compatible (ABO-C) liver transplantation (LT). Although patient survival was similar, ABO-I LT was inferior to ABO-C LT in graft survival and several ABO-I-related complications. Graft survival of ABO-I LT was comparable to that of ABO-C LT in pediatric patients and those using rituximab.