{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:36:16Z","timestamp":1791826576853,"version":"4.3.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T00:00:00Z","timestamp":1685491200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>ABO incompatible (ABOi) liver transplantation (LT) was initially associated with a higher incidence of vascular, biliary, and rejection complications and a lower survival than ABO compatible (ABOc) LT. Various protocols have been proposed to manage anti-isohemagglutinin antibodies and hyperacute rejection. We present our experience with a simplified protocol using only plasmapheresis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of all patients who received an ABOi LT at our\u00a0institution was performed. Comparisons were made based on era (early: 1997\u20132008, modern: 2009\u20132020) and severity of disease (status 1 vs. exception PELD at transplant). A pair-matched comparison was done to patients who received an ABOc LT. <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.05 was considered significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>17 patients received 18 ABOi LT (3 retransplants). Median age at transplant was 7.4 months (1.1\u201328.9). 66.7% patients were listed as status 1. Hepatic artery thrombosis (HAT) occurred in one patient (5.6%), there were 2 cases of portal vein thrombosis (PVT) (11.1%), and 2 biliary strictures (11.1%). Patient and graft survival improved in the ABOi modern era, although not significantly. In the pair-matched comparison, complications (HAT <jats:italic>p<\/jats:italic>\u2009=\u20090.29; PVT <jats:italic>p<\/jats:italic>\u2009=\u20090.37; biliary complications <jats:italic>p<\/jats:italic>\u2009=\u20090.15) and survival rates were similar. Patient and graft survivals were 100% in the non-status 1 ABOi patients compared to 67% (<jats:italic>p<\/jats:italic>\u2009=\u20090.11) and 58% (<jats:italic>p<\/jats:italic>\u2009=\u20090.081) respectively for patients who were transplanted as status 1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ABO incompatible liver transplants in infants with a high PELD score have excellent outcomes. Indications for ABO incompatible transplants should be liberalized to prevent deaths on the waiting list or deterioration of children with high PELD scores.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1092412","type":"journal-article","created":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T11:56:59Z","timestamp":1685534219000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Outcomes after ABO incompatible pediatric liver transplantation are comparable to ABO identical\/compatible transplant"],"prefix":"10.3389","volume":"11","author":[{"given":"Caroline P.","family":"Lemoine","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahima","family":"Keswani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Superina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1111\/ajt.16978","article-title":"OPTN\/SRTR 2020 annual data report: liver","volume":"22","author":"Kwong","year":"2022","journal-title":"Am J Transplant"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1097\/00007890-199504270-00009","article-title":"The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients","volume":"59","author":"Farges","year":"1995","journal-title":"Transplantation"},{"key":"B3","first-page":"489","article-title":"Antibody-mediated rejection of human orthotopic liver allografts. 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