Objective  To compare the clinical efficacy between pediatric ABO-incompatible liver transplantation (ILT) and ABO-compatible liver transplantation (CLT) by Meta-analysis.

  Methods  Relevant studies published until May 2017 were electronically retrieved from PubMed, Embase, Cochrane library, China national knowledge internet (CNKI), Wanfang and VIP databases. According to the inclusion and exclusion criteria, the publications eligible were screened and clinical data were extracted. Meta-analysis was performed using the random or fixed effect model analyses with Review Manager 5.3 statistical software.

  Results  Eleven retrospective cohort studies in English were selected. Meta-analysis demonstrated that the postoperative 1-year survival rate of the recipients in the ILT group was significantly lower than that in the CLT group odds ratio (OR)=0.64, 95% confidence interval (CI) 0.49-0.83, P=0.0007). In the ILT group, the incidence of postoperative rejection reactions was considerably higher compared with that in the CLT group (OR=1.96, 95% CI 1.03-3.72, P=0.04). No statistical significance was observed in the postoperative 3-and 10-year survival rate of the recipients, 1-, 3-and 10-year survival rate of the graft and the incidence of postoperative biliary tract complications between two groups (all P > 0.05).

  Conclusions  Compared with their CLT counterparts, the 1-year survival rate of the ILT recipients is lower, whereas the incidence of rejection reactions is higher. However, the long-term survival rate of both the recipient and graft and the incidence of biliary tract complications do not significantly differ between CLT and ILT. ILT is a relatively ideal option for emergent patients or those lacking of liver graft with compatible blood group for a long period of time.