Severe hepatic necrosis of unknown causes following ABO-incompatible liver transplantation

Emergency ABO-incompatible (ABO-I) liver transplantations (LTx) have been performed increasingly to treat severe liver failure.Herein,we report a case of severe hepatic necrosis after ABO-I LTx.A 53-year-old man with blood group O was diagnosed as having severe hepatitis B and acute-on-chronic liver failure,and underwent an emergency liver transplantation implanting a blood-group-B liver from a cardiac-death donor.A routine anti-rejection,anti-infection and anti-virus therapy was given after operation.On post-operative day (POD) 16,the recipient had fever and erythra.Laboratory and radiographic examinations suggested a severe hepatic necrosis of unknown causes.The patient was managed with a 10-d methylprednisolone pulse therapy.He was discharged on POD 35 with stable condition,and no recurrent disease was found during the follow-up.