Boberg K M, Foss A, Midtvedt K, Schrumpf E
Medical Department, Rikshospitalet, 0027 Oslo, Norway.
Clin Transplant. 2006 Mar-Apr;20(2):265-8. doi: 10.1111/j.1399-0012.2005.00470.x.
In patients with fulminant liver failure requiring emergency liver transplantation, the only donor organ that becomes available may be ABO incompatible. The risk of graft failure because of antibody-mediated acute rejection is high, but can be reduced by various means. We reported a deceased donor ABO-incompatible liver allograft recipient who was treated with antigen-specific immunoadsorption in combination with anti-CD20 monoclonal antibody and conventional plasmapheresis and immunosuppression. The patient was a 33-yr-old male with blood group A who presented with subacute liver failure of unknown aetiology and received a blood group AB liver graft. Pretransplant he underwent plasmapheresis and received one dose of rituximab. The immunosuppressive regimen consisted of methylprednisolone, tacrolimus and mycophenolate mofetil. Despite regular post-operative plasmapheresis sessions, anti-B antibody titres increased. Antigen-specific immunoadsorption with depletion of anti-B antibodies was performed from day nine to day 17. Thereafter, anti-B IgM and IgG antibody titres remained low. After one month the patient was reoperated with hepaticojejunostomy because of bile duct necrosis and with reconstruction of a stenotic hepatic artery. A mild rejection was successfully treated with methylprednisolone four months post-transplant. At six months post-transplant there was a stricture of the biliary-enteric anastomosis, but the graft was well functioning. We conclude that antigen-specific immunoadsorption can be an important adjuvant therapy to control recipient anti-A/B antibody levels and prevent acute rejection in ABO-incompatible deceased donor liver transplantation.
在需要紧急肝移植的暴发性肝衰竭患者中，唯一可用的供体器官可能是ABO血型不相容的。由于抗体介导的急性排斥反应导致移植物失败的风险很高，但可以通过多种方法降低。我们报告了一名接受已故供体ABO血型不相容肝移植的患者，该患者接受了抗原特异性免疫吸附联合抗CD20单克隆抗体以及传统血浆置换和免疫抑制治疗。患者为一名33岁男性，血型为A，因病因不明的亚急性肝衰竭就诊，并接受了AB血型的肝移植。移植前他接受了血浆置换并接受了一剂利妥昔单抗。免疫抑制方案包括甲泼尼龙、他克莫司和霉酚酸酯。尽管术后定期进行血浆置换，但抗B抗体滴度仍升高。从第9天到第17天进行了抗B抗体清除的抗原特异性免疫吸附。此后，抗B IgM和IgG抗体滴度保持较低水平。一个月后，患者因胆管坏死接受了肝空肠吻合术再次手术，并重建了狭窄的肝动脉。移植后四个月，轻度排斥反应通过甲泼尼龙成功治疗。移植后六个月，胆肠吻合口出现狭窄，但移植物功能良好。我们得出结论，抗原特异性免疫吸附可以作为一种重要的辅助治疗方法，以控制受体抗A/B抗体水平，并预防ABO血型不相容的已故供体肝移植中的急性排斥反应。
