Department of Blood Transfusion, Tianjin First Central Hospital, 24 Fukang Road, Tianjin, Nankai, China.
Pediatr Surg Int. 2020 Nov;36(11):1353-1362. doi: 10.1007/s00383-020-04746-5. Epub 2020 Oct 1.
ABO-incompatible (ABO-i) liver transplantation (LT) is a life-saving method for pediatric patients in emergency situations that has the potential to expand the pool of liver donors. However, the risks of ABO-i compared to ABO-compatible (ABO-c) LT are unclear. To address this clinical uncertainty, we conducted a systematic review and meta-analysis to compare clinical outcomes between ABO-i and ABO-c LT in pediatric patients.
A systematic search for studies comparing outcomes between ABO-i and ABO-c LT was performed in the MEDLINE (PubMed), EMBASE, and Cochrane Library databases through May 2020. Outcomes evaluated included graft survival rate, patient survival rate, rejection, infection, biliary complications, and vascular complications. Quality of evidence was assessed using the Newcastle-Ottawa scale. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3.
A total of 12 studies involving 7461 patients were included in the review. Meta-analysis of these studies showed significantly lower 1 year, 3 year, and 5 year graft survival rates for ABO-i vs. ABO-c LT (1 year: OR = 0.46, 95% CI 0.35-0.59, P < 0.00001; 3 years: OR = 0.47, 95% CI 0.36-0.63, P < 0.00001; 5 year: OR = 0.48, 95% CI 0.37-0.63, P < 0.00001) as well as significantly lower 1 year, 3 year, 5 year, and 10 year patient survival rates for ABO-i vs. ABO-c (1 year: OR = 0.34, 95% CI 0.24-0.49, P < 0.00001; 3 years: OR = 0.24, 95% CI 0.14-0.40, P < 0.00001; 5 years: OR = 0.47, 95% CI 0.35-0.64, P < 0.00001; 10 years: OR = 0.59, 95% CI 0.38-0.90, P = 0.02). No significant differences were observed between the groups in incidence of cytomegalovirus infection, acute cellular rejection, acute rejection, biliary complications, or hepatic artery thrombosis.
Our systematic review and meta-analysis showed consistently lower patient survival and graft survival in pediatric ABO-i LT compared to ABO-c LT. However, ABO-i LT is still a life-saving emergency option for pediatric patients waiting for a suitable liver source.
ABO 不相容（ABO-i）肝移植（LT）是一种为紧急情况下儿科患者提供的救命方法，它有可能扩大肝供体的来源。然而，ABO-i 与 ABO 相容（ABO-c）LT 相比的风险尚不清楚。为了解决这一临床不确定性，我们进行了一项系统评价和荟萃分析，比较了儿科患者 ABO-i 和 ABO-c LT 的临床结局。
在 MEDLINE（PubMed）、EMBASE 和 Cochrane 图书馆数据库中，通过 2020 年 5 月进行了一项系统检索，以比较 ABO-i 和 ABO-c LT 之间的结局。评估的结局包括移植物存活率、患者存活率、排斥反应、感染、胆漏并发症和血管并发症。使用纽卡斯尔-渥太华量表评估证据质量。使用 RevMan 5.3 计算合并的优势比（OR）和 95%置信区间（CI）。
共纳入了 12 项研究，涉及 7461 名患者。这些研究的荟萃分析显示，与 ABO-c LT 相比，ABO-i 组 1 年、3 年和 5 年的移植物存活率显著降低（1 年：OR=0.46，95%CI 0.35-0.59，P<0.00001；3 年：OR=0.47，95%CI 0.36-0.63，P<0.00001；5 年：OR=0.48，95%CI 0.37-0.63，P<0.00001），1 年、3 年、5 年和 10 年的患者存活率也显著降低（1 年：OR=0.34，95%CI 0.24-0.49，P<0.00001；3 年：OR=0.24，95%CI 0.14-0.40，P<0.00001；5 年：OR=0.47，95%CI 0.35-0.64，P<0.00001；10 年：OR=0.59，95%CI 0.38-0.90，P=0.02）。两组间巨细胞病毒感染、急性细胞排斥反应、急性排斥反应、胆漏并发症或肝动脉血栓形成的发生率无显著差异。
我们的系统评价和荟萃分析显示，与 ABO-c LT 相比，儿科 ABO-i LT 的患者存活率和移植物存活率始终较低。然而，ABO-i LT 仍然是儿科患者等待合适肝源时的一种救命的紧急选择。
