Current aspects of ABO-incompatible liver transplantation

Blood-group type matching has been well known as the principal rule in organ transplantation. However, as the possibility of obtaining grafts from living donors is very low, adjustment of blood type is sometimes very difficult. On the other hand, and particularly in Far East countries, it is even harder to obtain grafts from deceased donors; thus, living donors must be used for the rescue of patients with endstage liver disease. In Japan, this background has led to an increase of ABO-Incompatible (ABO-I) living donor transplantation, especially in the field of kidney transplantation. Although various therapeutic modalities emerged from the experience with renal transplantation, further adjusting strategies are required for the success of ABO-I liver transplantation [1]. Moreover, the hurdle posed by ABO-I liver transplantation is higher than that in kidney transplantation. This review describes the current advances of ABO-I liver transplantation including the achievements fruit of our predecessors’ efforts, and a proposal to improve outcomes and reduce ABO incompatibility related complications in liver transplantation.