ABO-incompatible (ABO-I) liver transplantation (LT) has been limited due to the increased rate of
complications, including severe cellular and antibody-mediated rejection, hepatic necrosis, hepatic artery thrombosis,
and biliary complications. However, several strategies for reducing preformed anti-donor ABO antibodies
and B cell desensitization have improved the outcomes of ABO-I LT. As a result, ABO-I LT has become a routine
procedure and is a feasible option in countries with a scarce deceased-organ donation or in cases without an
available compatible organ donor. In this review, we describe past and present desensitizing protocols as well as
emergent therapies for depleting B cell and anti-ABO antibodies with the objective of identifying approaches that
could lead to new, refined strategies for maximizing the results of ABO-I LT.