The suggestion of mitigating disparity in the liver transplantation field among ABO blood type.

Abstract

Medical literature highlights differences in liver transplantation(LT) waitlist experiences among ABO blood types. Type AB candidates reportedly have higher LT rates and reduced mortality. Despite liver offer guidelines, ABO disparities persist. This study examines LT access discrepancies among blood types, focusing on type AB, and seeks equitable strategies. Using the UNOS database(2003-2022), 170,276 waitlist candidates were retrospectively analyzed. Dual predictive analyses(LT Opportunity&Survival Studies) evaluated 1-year recipient pool survival, considering waitlist and post-LT survival, alongside anticipated allocation value per recipient, under six scenarios. Of the cohort, 97,670 patients(57.2%) underwent LT. Type AB recipients had the highest LT rate(73.7vs55.2% for O), shortest median waiting time(90vs198days for A), and lowest waitlist mortality(12.9vs23.9% for O), with the lowest median MELD-Na score(20vs25 for A/O). The LT Opportunity Study revealed that reallocating type A(or A&O) donors-originally for AB recipients-to A recipients yielded the greatest reduction in disparities in anticipated value per recipient, from 0.19(before modification) to 0.08. Meanwhile, the Survival Study showed that ABO-identical LTs reduced disparity most(3.5% to 2.8%). Sensitivity analysis confirmed these findings were specific to the MELD-Na<30 population, indicating current LT allocation may favor certain blood types. Prioritizing ABO-identical LTs for MELD-Na<30 recipients could ensure uniform survival outcomes and mitigate disparities.

View details for DOI 10.1016/j.ajt.2024.06.004

View details for PubMedID 38866110