Indian Journal of Gastroenterology

, Volume 38, Issue 1, pp 23–28 | Cite as

Lessons learnt from living donor liver transplantation with ABO-incompatibility: A single-centre experience from southern India

  • Surumi Shajahan
  • Sreedurga Thottanchery Sasidharan
  • Sudhindran Surendran
  • Veena Shenoy
  • Uma Devi PadmaEmail author
Original Article



Although, ABO-incompatible (ABOi) liver transplantation is considered a high-risk procedure, using newer and more effective preoperative B cell desensitisation techniques, many transplant centres are routinely performing ABOi living donor liver transplantation (LDLT).


This was a retrospective study of 12 patients (adult:pediatric = 10:2; M:F = 9:3; median age, 45.5 years [range 1 to 56 years]) who underwent ABOi LDLT at a tertiary care centre.


The median model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) scores were 28 (range 18 to 35) and 30.5 (range 24 to 37), respectively. For desensitisation, we initially used two doses of rituximab and two sessions of plasmapheresis preoperatively. We faced high mortality in the initial seven patients (five deaths) due to overwhelming sepsis from multidrug-resistant (MDR) pathogens. Subsequently, we restricted the rituximab to one dose and performed plasmapheresis only when isoagglutinin titre value was more than 1:64. With this regimen, out of the last five patients, four did well. For the whole cohort, the incidence of antibody-mediated rejection, acute cellular rejection, biliary complications, hepatic artery thrombosis, infection, and 5-year patient survival were 16.7%, 16.7%, 16.7%, 8.3%, 75%, and 40%, respectively. The risk factors for mortality were high MELD score, O blood group, and more intense desensitisation protocol.


Careful selection of patients and less intense desensitisation protocol are probably important in improving the outcomes in ABOi LDLT.


ABO-incompatibility Complications Desensitisation Infection 


Author contributions

SS and STS were involved in collecting data, and preparing the initial draft of the manuscript.

SS, VS and UDP were involved in analysis of data and critical revision of the manuscript for intellectual content.

Compliance with ethical standards

Conflict of interest

SS, STS, SS, VS, and UDP declare that they have no conflict of interest.

Ethical clearance

The authors declare that the study was performed in a manner conforming to the Helsinki declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and the authors followed the policy concerning informed consent as shown on


The authors are solely responsible for the data and the content of the paper. In no way, the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.

Supplementary material

12664_2019_933_MOESM1_ESM.docx (14 kb)
ESM 1 (DOCX 12 kb)


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Copyright information

© Indian Society of Gastroenterology 2019

Authors and Affiliations

  • Surumi Shajahan
    • 1
  • Sreedurga Thottanchery Sasidharan
    • 2
  • Sudhindran Surendran
    • 3
  • Veena Shenoy
    • 4
  • Uma Devi Padma
    • 1
    Email author
  1. 1.Department of PharmacologyAmrita School of PharmacyKochiIndia
  2. 2.Department of Pharmacy PracticeAmrita School of PharmacyKochiIndia
  3. 3.Department of Gastrointestinal Surgery and Solid Organ TransplantationAmrita Institute of Medical Sciences and Research CentreKochiIndia
  4. 4.Department of Transfusion MedicineAmrita Institute of Medical Sciences and Research CentreKochiIndia

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