Skogsberg Ulrika, Breimer Michael E, Friman Styrbjörn, Mjörnstedt Lars, Mölne Johan, Olausson Michael, Rydberg Lennart, Svalander Christian T, Bäckman Lars
Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
Xenotransplantation. 2006 Mar;13(2):154-9. doi: 10.1111/j.1399-3089.2006.00286.x.
The longer waiting time for a liver graft in patients with blood group O makes it necessary to expand the donor pool for these patients. This applies in both urgent situations and for elective patients. We report on our experience with ABO-incompatible liver transplantation using A2 and B non-secretor donors here.
Between 1996 and 2005, 12 adult blood group O recipients (seven male/five female) received ABO-incompatible cadaveric liver grafts (10 A2 donors, two B non-secretor donors). The indications were either rapid deterioration of liver function or hepatocellular cancer, in blood group O recipients, where an ABO-identical/compatible graft was not available. Mean recipient age was 54+/-8 (mean+/-SD) yr. All pre-operative CDC crossmatches were negative. The initial immunosuppression was induction therapy with antithymocyte globulin (n = 3), interleukin 2 receptor antagonists (n = 3) or anti-CD20 antibody (rituximab) (n = 1), followed by a tacrolimus-based protocol. Three patients underwent plasmapheresis post-transplantation. Baseline biopsies were taken before or immediately after reperfusion of the graft and after grafting when clinically indicated. No pre-operative plasmapheresis, immunoadsorption or splenectomies were performed.
Patient and graft survival was 10/12 (83%) and 8/12 (67%), respectively, with a 6.5-month median follow-up (range 10 days to 109 months). Two patients (B non-secretor grafts) died of multiorgan failure probably because of a poor condition before transplantation. Three patients were retransplanted. Causes of graft loss were bacterial arteritis (n = 1), death with a functioning graft (n = 1) and portal vein thrombosis (n = 2). In one of the patients with portal vein thrombosis, an anti-A titer increase occurred concomitantly, and ABO incompatibility as the cause of the thrombosis cannot be excluded. Seven acute rejections occurred in five patients and all were reversed by steroids or increased tacrolimus dosage. The pre-transplant anti-A titers tested against A1 red blood cells were 1 to 128 (NaCl technique) and 4 to 1024 (indirect antiglobulin technique, IAT); the maximum postoperative titers were 16 to 2048 (NaCl) and 256 to 32,000 (IAT).
The favorable outcome of A2 to O grafting, with a patient survival of 10/10 and a graft survival of 8/10, makes it possible to also consider this blood group combination in non-urgent situations. The use of non-secretor donor grafts is interesting but has to be further documented. There was no hyperacute rejection or increased rate of rejection. Anti-A/B titer changes seem not to play a significant role in the monitoring of ABO-incompatible liver transplantation.
O型血患者等待肝移植的时间较长，因此有必要扩大这些患者的供体库。这在紧急情况和择期患者中均适用。我们在此报告使用A2型和B型非分泌型供体进行ABO血型不相容肝移植的经验。
1996年至2005年期间，12例成年O型血受者（7例男性/5例女性）接受了ABO血型不相容的尸体肝移植（10例A2型供体，2例B型非分泌型供体）。适应证为O型血受者肝功能迅速恶化或肝细胞癌，且无法获得ABO血型相同/相容的移植物。受者平均年龄为54±8（平均±标准差）岁。所有术前CDC交叉配血均为阴性。初始免疫抑制采用抗胸腺细胞球蛋白诱导治疗（n = 3）、白细胞介素2受体拮抗剂（n = 3）或抗CD20抗体（利妥昔单抗）（n = 1），随后采用基于他克莫司的方案。3例患者在移植后进行了血浆置换。在移植肝再灌注前或后以及临床指征明确时进行基线活检。未进行术前血浆置换、免疫吸附或脾切除术。
患者和移植物存活率分别为10/12（83%）和8/12（67%），中位随访时间为6.5个月（范围10天至109个月）。2例患者（B型非分泌型移植物）死于多器官功能衰竭，可能是因为移植前状况不佳。3例患者接受了再次移植。移植物丢失的原因是细菌性动脉炎（n = 1）、移植物功能良好时死亡（n = 1）和门静脉血栓形成（n = 2）。在1例门静脉血栓形成的患者中，抗A滴度同时升高，不能排除ABO血型不相容是血栓形成的原因。5例患者发生了7次急性排斥反应，所有排斥反应均通过类固醇或增加他克莫司剂量得到逆转。移植前针对A1红细胞检测的抗A滴度为1至128（NaCl技术）和4至1024（间接抗球蛋白技术，IAT）；术后最高滴度为16至2048（NaCl）和256至32,000（IAT）。
A2型到O型移植的良好结果，患者存活率为10/10，移植物存活率为8/10，使得在非紧急情况下也可以考虑这种血型组合。使用非分泌型供体移植物很有意义，但必须进一步记录。未发生超急性排斥反应或排斥反应发生率增加。抗A/B滴度变化似乎在ABO血型不相容肝移植的监测中不起重要作用。
