Shimoda Masafumi, Marubashi Shigeru, Dono Keizo, Miyamoto Atsushi, Takeda Yutaka, Umeshita Koji, Nagano Hiroaki, Hoshida Yoshihiko, Monden Morito
Department of Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Hepatogastroenterology. 2009 Jul-Aug;56(93):1174-7.
In comparison with ABO-compatible cases, ABO-incompatible liver transplantation has an increased risk of humoral rejection. The risk factors are the recipient's age (> or = 16 years) and elevated titers of anti-donor blood group antibodies. We report a case of adult A-to-O liver transplantation in which the recipient's preoperative IgG titer was 1:8192. Plasmapheresis, splenectomy, rituximab administration, and liver-directed anticoagulation therapy in addition to conventional immunosuppression effectively suppressed the antibody titer, thereby preventing humoral rejection. Preoperative administration of rituximab alone had minimal impact on antibody production, and a substantial amount of plasma cells remained in the spleen. This result is encouraging for high-risk ABO-incompatible liver transplantation and we recommend splenectomy combined with rituximab administration for such cases. Additionally, postoperative modulation of the recipient's immunity to the ABO-incompatible graft was noted, which is necessary for long-term survival of an ABO-mismatched allograft.
与ABO血型相容的病例相比，ABO血型不相容的肝移植发生体液排斥反应的风险增加。风险因素包括受者年龄（≥16岁）和抗供体血型抗体滴度升高。我们报告一例成人A到O型肝移植病例，该受者术前IgG滴度为1:8192。除常规免疫抑制外，血浆置换、脾切除术、利妥昔单抗给药及肝脏定向抗凝治疗有效抑制了抗体滴度，从而预防了体液排斥反应。单独术前给予利妥昔单抗对抗体产生的影响极小，且脾脏中仍存在大量浆细胞。这一结果对于高风险ABO血型不相容肝移植是令人鼓舞的，我们建议对此类病例采用脾切除术联合利妥昔单抗给药。此外，还注意到受者对ABO血型不相容移植物的免疫在术后发生了调节，这对于ABO血型不匹配同种异体移植物的长期存活是必要的。
