Poor results after ABO-incompatible living donor liver transplantation (LDLT) are closely associated with severe hyperacute rejection due to the presence of anti-donor ABO antibodies during the early postoperative period. Nonetheless, ABO-incompatible LDLT has not been abandoned, and several different protocols have been proposed with the aim of avoiding acute graft necrosis and chronic biliary damage, both of which are recognized as major causes of poor outcome. Plasmapheresis to decrease anti-ABO titers and rituximab prophylaxis have been utilized to improve the outcome of ABO-incompatible LDLT. The lack of alternatives to LDLT provides a strong ongoing justification for performing ABO-incompatible LDLT in Korea.

Keywords: ABO blood-group system, Rituximab, Plasmapheresis, Treatment