A Brief History of Abo-incompatible Liver Transplantation

The annual number of liver transplantation (LT) in Korea has continuously increased, mainly due to the explosive rise in the number of living donor liver transplants (LDLT) (Fig. 1A) [1]. However, LT cannot keep pace with the increase in the size of the waiting list in Korea despite the recent gradual boost in deceased donor numbers (Fig. 1B) [1]. Therefore, expanding the liver donor pool has always been a major challenge for Korean society. The potential for expanding the deceased donor pool in our country seems to be limited and expansion of the living donor pool is generally hampered by insuperable ethical and donor safety issues. Hence, the involvement of ABO-incompatible (ABOi) donors is an attractive solution for the organ shortage because it does not add to donor risk and is potentially very effective. However, widespread application of ABOi LT has been limited by serious concerns about recipient outcomes due to disappointing early experience. ABOi organ transplantation has definitely undergone a paradigm shift since the introduction of the anti-CD20 monoclonal antibody, rituximab. Survival outcomes have become comparable to those of ABO-compatible transplantation due to various novel strategies for desensitization (DSZ). In this review, I present a brief history of recent achievements in ABOi LT, focussing on current trends in DSZ protocols, provide the clinical outcomes of the Korean experience in ABOi LDLT and suggest further steps for improving clinical outcomes.