Published online Dec 27, 2023. doi: 10.4240/wjgs.v15.i12.2727
Peer-review started: September 11, 2023
First decision: October 9, 2023
Revised: October 18, 2023
Accepted: December 1, 2023
Article in press: December 1, 2023
Published online: December 27, 2023
Processing time: 106 Days and 22.5 Hours
ABO-incompatible (ABOi) liver transplantation (LT) has posed significant challenges due to its impact on graft survival and the occurrence of complications like antibody-mediated rejection (AMR). The outcomes of ABOi living-donor LT (LDLT) have shown considerable variability in previous studies. This research aimed to investigate the long-term outcomes of ABOi LDLT and associated risk factors.
Understanding the factors that influence graft survival (GS) and complications in ABOi LDLT recipients is essential for improving the clinical outcomes. Identifying the impact of tacrolimus concentration on graft outcomes, especially in patients with or without hepatocellular carcinoma (HCC), can provide valuable insights for optimizing immunosuppressive therapy.
The primary objectives of this study were to assess the long-term graft outcomes in ABOi LDLT and analyze the associated risk factors. Subgroup analyses were performed to evaluate GS and risk factors based on the presence or absence of HCC. Additionally, the study aimed to investigate the influence of serial serum tacrolimus trough concentration on graft outcomes in both HCC and non-HCC recipients.
A retrospective analysis was conducted on a cohort of 89 ABOi LDLT recipients. Various clinical, laboratory, and radiological data were collected for each patient. Desensitization and immunosuppression protocols were followed, including the use of rituximab and tacrolimus. The impact of tacrolimus trough concentration on GS and HCC recurrence was analyzed using statistical methods.
The study found that AMR was a common risk factor affecting GS in both HCC and non-HCC ABOi LDLT recipients. Early exposure to high tacrolimus concentrations was associated with HCC recurrence, while lower concentrations at later time points were linked to poorer long-term graft outcomes in non-HCC patients. Maintaining a narrow range of tacrolimus concentrations between 5.4 and 7.3 ng/mL may be beneficial.
This research highlighted the importance of monitoring and managing the calcineurin inhibitor (CNI) concentrations in ABOi LDLT recipients. The study also suggested that tailoring tacrolimus concentration based on the presence of HCC can optimize graft outcomes. Minimizing CNIs, especially in HCC patients, may reduce the risk of HCC recurrence.
Future studies should validate the optimal tacrolimus concentration cutoffs and explore additional strategies to improve the outcomes of ABOi LDLT recipients. Multicenter studies considering various risk factors are warranted to develop predictive models for this patient population.