Outcomes of emergency pediatric ABO-incompatible living donor liver transplantation in Korea

Background: Emergency pediatric living donor liver transplantation (LDLT) is vital for acute liver failure patients in life-threatening situations.However, we do not know the outcomes of emergency pediatric ABO-incompatible (ABOi)-LDLT, which is an alternative treatment for patients without ABO-compatible (ABOc) living liver donors.The purpose of our study is to compare the outcomes between emergency pediatric ABOi-LDLT and emergency pediatric ABOc-LDLT using data from the Korean Network for Organ Sharing (KONOS).Methods: We analyzed retrospective KONOS data for consecutive pediatric emergency LDLT patients between 2017 and 2021 in Korea. Results:The incidence of ABOc-LDLT and ABOi-LDLT was 83% (n=44) and 17% (n=9), respectively.The baseline, pre-transplant care, postoperative complications, and infectious complications of ABOi-LDLT did not differ from those of ABOc-LDLT.Graft survival and overall survival at 5 years in ABOi-LDLT were 100% and 100%, respectively, which was better than in ABOc-LDLT, but the survival difference between the two groups was not significant.No developed acute rejection in ABOi-LDLT patients.No factors in the multivariate analysis were related to patient mortality or graft failure.Neither graft failure nor death was associated with ABOi-LDLT. Conclusion:This study concludes that emergency pediatric ABOi-LDLT is safe and feasible for use in ALF patients as well as other urgent instances.