Matsuno N, Iwamoto H, Nakamura Y, Hama K, Kihara Y, Konno O, Jojima Y, Akashi I, Mijiti A, Ashizawa T, Nagao T
5th Department of Surgery, Hachioji Medical Center of Tokyo Medical University, Tokyo, Japan.
Transplant Proc. 2008 Oct;40(8):2497-500. doi: 10.1016/j.transproceed.2008.07.054.
Living donor liver transplantation (LDLT) offers timely transplantation for patients with hepatocellular carcinoma (HCC). If ABO-incompatible LDLT is feasible, the need for pretransplantation treatment may be eliminated, which may reduce overall morbidity. In this article, we have described 8 adult HCC patients who successfully underwent LDLT from ABO-incompatible donors. Antirejection therapy included multiple preoperative plasmaphereses, splenectomy, and an immunosuppressive regimen with tacrolimus, methylprednisolone, and mycophenolate mofetil. The maintenance dose of immunosuppression did not differ from that of the ABO-identical cases. In addition, we also performed intrahepatic arterial infusion of prostaglandin E1. In 5 patients, we administered a single dose of rituximab, a chimeric CD20 monoclonal antibody. As a result of this treatment, 6/8 patients are still alive. Our experience has shown that it is possible to control antibody-mediated humoral rejection and other complications in adult ABO-incompatible LDLT.
活体供肝肝移植（LDLT）为肝细胞癌（HCC）患者提供了及时的肝移植机会。如果ABO血型不相容的LDLT可行，可能无需进行移植前治疗，这可能会降低总体发病率。在本文中，我们描述了8例成功接受ABO血型不相容供体LDLT的成年HCC患者。抗排斥治疗包括多次术前血浆置换、脾切除术以及使用他克莫司、甲泼尼龙和霉酚酸酯的免疫抑制方案。免疫抑制的维持剂量与ABO血型相同的病例没有差异。此外，我们还进行了肝动脉内前列腺素E1输注。在5例患者中，我们给予了单剂量的利妥昔单抗，一种嵌合型CD20单克隆抗体。经过这种治疗，8例患者中有6例仍然存活。我们的经验表明，在成人ABO血型不相容的LDLT中，控制抗体介导的体液排斥和其他并发症是可能的。
