Objective：To evaluate the effectiveness of a new strategy in ABO-incompatible liver transplantation.
Methods：We retrospectively analyzed the clinical records of 4 cases of ABO-incompatible  allogeneic orthotopic liver transplantation performed in our hospital. Among them, 3 blood type O recipients received livers from blood type AB donors, and one type A RH（-）recipient received liver from blood type AB RH（+）donor. A new strategy of perioperative mangement was used for prevention of acute rejection, that included perioperative mangement with quadri-immunosuppressant, PPE, postoperational infusion of IVIG and prostaglandin E1, splenectomy and De-Escalation of antibiotics to prevent and treat postoperative infection.
Results：One patient had antibody-mediated rejection three days after operation and recovered after plasma exchange combined with high dose steroid treatments; 2 patients had acute renal failure and recovered after continuous venovenous hemofiltration(CVVH) for 2 weeks. All patients had infection postoperatively, but all  were cured and successfally discharged. Through 2-10 months of follow up, all patients have survived with normal hepatic and renal function.
Conclusions：The use of quadri-immunosuppression, PPE, postoperational infusion of IVIG and prostaglandin E1, splenectomy and De-Escalation of antibiotics  may be an effective strategy for ABO- incompatible liver transplantation.