Matsuno Naoto, Nakamura Yuki, Mejit Abudushukur, Hama Koichiro, Iwamoto Hitoshi, Konno Osamu, Jojima Yoshimaro, Akashi Isao, Iwahori Tohru, Ashizawa Tatsuhito, Nagao Takeshi
Department of Surgery, Hachioji Medical Center, Tokyo Medical University, Hachioji, Tokyo, Japan.
Clin Transplant. 2007 Sep-Oct;21(5):638-42. doi: 10.1111/j.1399-0012.2007.00702.x.
ABO-incompatible liver transplantation is usually contraindicated. The presence in the recipient of preformed anti-A/B antibodies located on endothelial cells raises the risk of antibody-mediated humoral rejection of the graft. We describe four successful cases of steroid withdrawal in adult patients who had living-donor liver transplantation from ABO-incompatible donors. Antirejection therapy included multiple perioperative plasmapheresis, splenectomy, and a triple immunosuppressive regimen with tacrolimus, methylprednisolone (MPSL), and cyclophosphamide or mycophenolate mofetil (MMF). The maintenance dose of immunosuppression did not differ from that of ABO-identical cases. After transplantation, intrahepatic arterial infusion therapy with prostaglandin E1 (PG E1) was used. As a result, all four patients were able to achieve long-term graft survival without steroid use. They all have good liver function and are leading normal lifestyles. Our experience with these four patients suggests the feasibility of controlling humoral rejection and other complications in adult ABO-incompatible living donor liver transplantations with intrahepatic arterial infusion of PGE1, splenectomy, and plasmapheresis with a regular base of immunosuppression protocol to prevent antibody-mediated humoral rejection.
ABO血型不相容的肝移植通常是禁忌的。受者体内位于内皮细胞上的预先形成的抗A/B抗体增加了移植物抗体介导的体液排斥反应的风险。我们描述了4例成年患者成功停用类固醇的案例，这些患者接受了来自ABO血型不相容供体的活体肝移植。抗排斥治疗包括围手术期多次血浆置换、脾切除术以及使用他克莫司、甲泼尼龙（MPSL）和环磷酰胺或霉酚酸酯（MMF）的三联免疫抑制方案。免疫抑制的维持剂量与ABO血型相同的病例没有差异。移植后，采用前列腺素E1（PGE1）进行肝内动脉灌注治疗。结果，所有4例患者均能在不使用类固醇的情况下实现长期移植物存活。他们的肝功能均良好，过着正常的生活方式。我们对这4例患者的经验表明，通过肝内动脉灌注PGE1、脾切除术以及定期进行血浆置换并结合常规免疫抑制方案来预防抗体介导的体液排斥反应，在成人ABO血型不相容的活体肝移植中控制体液排斥反应和其他并发症是可行的。
