Kawagishi N, Satoh K, Enomoto Y, Akamatsu Y, Sekiguchi S, Fukumori T, Fujimori K, Satomi S
Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Transplant Proc. 2005 Mar;37(2):1205-6. doi: 10.1016/j.transproceed.2004.12.114.
It is more difficult to control humoral rejection in living donor liver transplantations (LDLT) across the ABO blood group barrier than in matched or compatible combinations. We achieved excellent results in ABO-incompatible transplantation with novel immunosuppressive regimens and plasma exchange (PE). Among 82 LDLT were 10 cases of ABO-incompatible recipients, including three who were administered rituximab for rescue or prophylactic therapy. Pretransplantation PE was performed as necessary to maintain hemagglutinin titers below 1:16 and posttransplantation PE was performed when there were signs of hyperacute rejection associated with high titers. Induction immunosuppression consisted of FK506, steroid, mycophenolate mofetil (MMF), and rituximab. The first patient was administered rituximab with deoxyspergualin (DSG), steroid pulse therapy, and PE on postoperative day (POD) 7, because of biopsy-proven humoral acute rejection. The titers and LFTs improved drastically. The second and third patients were administered rituximab just after the operation with other routine immunosuppressants for prophylaxis of hyperacute rejection. The second patient showed a slight deterioration in LFTs with an elevated titer, which normalized after steroid pulse therapy and PE. The third patient had no episodes of rejection. At present, that is 27, 17, and 6 months after the operations respectively, the 3 transplant recipients are in stable condition.
与血型匹配或相容的活体供肝移植（LDLT）相比，跨越ABO血型屏障的活体供肝移植中控制体液性排斥反应更为困难。我们采用新型免疫抑制方案和血浆置换（PE）在ABO血型不相容移植中取得了优异的效果。在82例LDLT中，有10例ABO血型不相容的受者，其中3例接受了利妥昔单抗进行挽救或预防性治疗。必要时进行术前血浆置换以维持血凝素滴度低于1:16，出现与高滴度相关的超急性排斥反应迹象时进行术后血浆置换。诱导免疫抑制包括FK506、类固醇、霉酚酸酯（MMF）和利妥昔单抗。第一例患者因活检证实为体液性急性排斥反应，于术后第7天接受利妥昔单抗联合去氧精胍菌素（DSG）、类固醇冲击治疗和血浆置换。滴度和肝功能检查结果大幅改善。第二例和第三例患者在术后立即接受利妥昔单抗及其他常规免疫抑制剂治疗以预防超急性排斥反应。第二例患者肝功能检查结果稍有恶化且滴度升高，经类固醇冲击治疗和血浆置换后恢复正常。第三例患者未发生排斥反应。目前，这3例移植受者分别在术后27个月、17个月和6个月，病情稳定。
