Background: Intrahepatic cholangiopathy is a rare but life-threatening sequela of ABO-incompatible liver transplantation. This study analyzed the clinical impact of using pretransplant mycophenolate mofetil for reducing intrahepatic cholangiopathy in ABO-incompatible liver transplantation.
Methods: Patients who underwent living donor liver transplantation at Samsung Medical Center between 2010 and April, 2022 were included. Pretransplant mycophenolate mofetil was started since November, 2020. Comparison between ABO-compatible and ABO-incompatible transplantation was performed. Among ABO-incompatible transplantation, groups were divided into open donor surgery, laparoscopic donor surgery without pretransplant mycophenolate mofetil and laparoscopic donor surgery with pretransplant mycophenolate mofetil. Cox regression analyses on risk factors for intrahepatic cholangiopathy was performed.
Results: A total of 1,037 transplantations, 802 ABO-compatible and 234 ABO-incompatible transplantations were included. The intrahepatic cholangiopathy rate in ABO-incompatible transplantation with laparoscopic donor surgery (13/143, 9.1%) was significantly higher than that of ABO-compatible transplantation. (1/419, 0.2%; P<0.001) Multivariable analysis showed that laparoscopic donor surgery without pretransplant mycophenolate mofetil of recipients were at higher risk of intrahepatic cholangiopathy (hazard ratio [HR], 13.449; confidence interval [CI], 1.710–05.800; P=0.014) compared to open donor surgery group, while laparoscopic donor surgery with pretransplant mycophenolate mofetil showed no increased risk. (HR, 5.307; CI, 0.315–89.366; P=0.247).
Conclusions: Laparoscopic donor surgery was a risk factor for intrahepatic cholangiopathy in ABO-incompatible liver transplantation and pretransplant mycophenolate mofetil can reduce the risk if intrahepatic cholangiopathy.