Introduction : ABO incompatible living donor liver transplantation (ABOi LDLT) could be one of the treatment options for hepatocellular carcinoma (HCC) to overcome organ scarcity. However, desensitization protocol including B cell depletion besides traditional T cell suppression could be a risk factor for HCC recurrence that is a major cause of graft failure and patient death. We analyzed oncologic outcomes of ABOi LDLT comparing to ABO compatible LDLT.

Methods : The data of 101 recipients who underwent LDLT for HCC were prospectively collected and reviewed. Of the patients, 21 patients underwent ABOi LT. We compared the pre- and post-transplant tumor factors, HCC recurrence and survival between ABOi and ABOc LT.

Results : There was no significant difference in pre-transplant tumor staging, recipient and donor demographics between the groups. One and 3-year recurrence-free survival rates were 89.8% and 86.9% for the ABOc LT group and 85.4% and 80.1% for the ABOi LT, respectively (P=0.439). One and 3-year overall survival rates were 96.3% and 88.1% for the ABOc LT group and 90.5% and 85.2% for the ABOi LT, respectively (P=0.651). In multivariate analysis, a pre-transplant AFP level over 400 ng/mL was the only independent risk factor for HCC recurrence and poor patient survival.

Conclusions : The HCC recurrence survival and overall survival of ABOi LT were comparable to those of ABOc LT. ABOi LT is safe and feasible option for HCC patients.