Understanding ABO Incompatible Liver Transplantation: How It Works and Who Can Donate?

Liver Transplant
Liver Transplant

Liver transplantation is a life-saving procedure for individuals with end-stage liver disease. Traditionally, liver transplants require compatibility between the blood types of the donor and recipient. However, ABO incompatible liver transplantation offers a promising alternative for patients who may not have a compatible donor available. In this comprehensive guide, we'll delve into the intricacies of ABO incompatible liver transplantation, exploring how it works, who can be a donor, and its potential benefits and challenges.

As Dr Pradeep, Consultant specializing in HPB, GI & Liver Transplant Surgery, aptly states, "ABO incompatible liver transplantation represents a promising avenue in expanding the donor pool for patients in need of liver transplants. By leveraging innovative strategies and careful patient selection, we can offer hope and healing to individuals facing end-stage liver disease, ultimately improving their quality of life and prognosis."


Understanding ABO Incompatible Liver Transplantation:

In ABO incompatible liver transplantation, the donor and recipient have different blood types (e.g., donor blood type A and recipient blood type B). This approach expands the pool of potential donors for patients in need of a liver transplant, as it allows for transplantation across blood type barriers. Unlike ABO compatible transplants, where the donor and recipient have compatible blood types, ABO incompatible transplants require additional strategies to prevent immune rejection of the transplanted liver.


How Does It Work?

The success of ABO incompatible liver transplantation hinges on several key factors:

  • Preconditioning: Before the transplant, recipients undergo a process known as preconditioning, which involves removing antibodies from their bloodstream to reduce the risk of rejection.
  • Desensitization: Recipients receive medications, such as rituximab and intravenous immunoglobulin (IVIG), to further suppress their immune system and prevent antibody-mediated rejection.
  • Plasmapheresis: Plasma exchange or plasmapheresis may be performed to remove circulating antibodies from the recipient's bloodstream to an acceptable limit(<1:8) reducing the risk of rejection
  • Immunosuppression: Recipients receive immunosuppressive medications following the transplant to prevent rejection and promote acceptance of the donor liver.


Who Can Be a Donor?

In ABO incompatible liver transplantation, the donor's blood type may differ from the recipient's blood type. However, certain considerations must be taken into account when selecting a donor:

  • Compatibility: While the donor and recipient may have different blood types, other factors such as liver size, anatomy, and overall health must still be considered to ensure a successful transplant.  Donors must be above 18years of age and should be blood relatives.
  • Medical Evaluation: Potential donors undergo a thorough medical evaluation to assess their suitability for donation, including liver function tests, imaging studies, and psychosocial assessments.


Benefits and Challenges:

ABO incompatible liver transplantation offers several potential benefits, including:

  • Expanded Donor Pool: ABO incompatible transplantation allows for transplantation from donors who would otherwise be considered incompatible, potentially reducing wait times and improving access to transplantation.
  • Timely Transplantation: For patients with urgent medical needs or limited time on the transplant waiting list, ABO incompatible transplantation may offer a faster route to transplantation.
  • Challenges: Despite its potential benefits, ABO incompatible liver transplantation presents unique challenges, including a higher risk of antibody-mediated rejection, need for intensive immunosuppressive therapy and increased risk of infection. So choosing a suitable recipient is the key to success.


ABO incompatible liver transplantation has emerged as a valuable option for patients in need of a liver transplant who do not have access to a compatible donor. By expanding the donor pool and offering a potential lifeline to patients facing dire medical circumstances, ABO incompatible transplantation represents a significant advancement in the field of liver transplantation. However, careful patient selection, meticulous pretransplant conditioning, and vigilant post-transplant monitoring are essential to ensure the success and long-term viability of ABO incompatible liver transplants. Through ongoing research, innovation, and collaboration, we can continue to refine and optimize ABO incompatible transplantation, providing hope and healing to individuals awaiting a second chance at life.


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