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The acceptance of ABO-incompatible (ABOi) liver grafts will expand the donor pool for a patient in urgent need for a liver transplantation (LT). Here we report our results with emergency ABOi DD (deceased donor) LT using rituximab and antigen specific immunoadsorption. 2009 to 2019 we performed 20 ABOi DD LTs (adults  n  = 17, children  n  = 3) for patients in urgent need for a LT. Immunosuppression consisted of rituximab ( n  = 20) and basiliximab ( n  = 15) or anti-thymocyte globuline ( n  = 4), intravenous immunoglobulin (IVIG;  n  = 6), tacrolimus, prednisolone and mycophenolate mofetil. Fifteen patients were treated with IA ( n  = 14) or both IA and plasmapheresis (PP;  n  = 1) pre-transplant and 18 patients were treated with IA ( n  = 15) or both IA and PP ( n  = 3) post-transplant. The median pre-transplant MELD- score was 40 (range 18–40). Patient and graft survival and complications were compared to a 1:4 case matched control group of ABO-identical or compatible (ABOid/c) DDLT. The 1-, 3- and 5-year patient and graft survival rates were 85, 85 and 78% for the ABOi recipients and not significantly different compared to ABOid/c controls. Only one ABOi patient developed antibody-mediated rejection. Patient and graft survival after emergency ABOi DDLT using rituximab and immunoadorption was equal to ABOid/DDLT. ABOi DD LT was a successful approach to expand the donor pool for patients in urgent need for a liver graft.

Excellent outcome following emergency deceased donor ABO-incompatible liver transplantation using rituximab and antigen specific immunoadsorption