A2 型血向 O 型血的肝移植安全性：美国器官共享网络数据库分析。

Safety of blood group A2-to-O liver transplantation: an analysis of the United Network of Organ Sharing database.

机构信息

Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.

出版信息

Transplantation. 2012 Sep 15;94(5):526-31. doi: 10.1097/TP.0b013e31825c591e.

DOI:10.1097/TP.0b013e31825c591e

PMID:22874840

Abstract

BACKGROUND

ABO-incompatible organ transplantation typically induces hyperacute rejection. A2-to-O liver transplantations have been successful. This study compared overall and graft survival in O recipients of A2 and O grafts based on Organ Procurement and Transplantation Network data.

METHODS

Scientific Registry of Transplant Recipients data were used. The first A2-to-O liver transplantation was entered on March 11, 1990; all previous transplantations were excluded. Between March 11, 1990, and September 3, 2010, 43,335 O recipients underwent transplanation, of whom 358 received A2 grafts.

RESULTS

There were no significant differences in age, sex, and race between the groups. Recipients of A2 grafts versus O grafts were significantly more likely to be hospitalized at transplantation (45% vs. 38%, P≤0.05) and to have a higher mean (SD) model for end-stage liver disease score (24 [11] vs. 22 [10], P≤0.05). 10% of A2 recipients and 9% of O recipients underwent retransplantation. No significant differences existed in rejection during the transplantation admission and at 12 months: 7% versus 6% and 20% versus 22% for A2 recipients and O recipients, respectively; and there were no significant differences in contributing factors to graft failure or cause of death. At 5 years, overall survival of A2 and O graft recipients was 77% and 74%, respectively (log rank=0.71). At 5 years, graft survival was 66% in both groups (log rank=0.52). Donor blood group was insignificant on Cox regression for overall and graft survival.

CONCLUSIONS

Using Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients data, we present the largest series of A2-to-O liver transplantations and conclude this mismatch option to be safe with similar overall and graft survival. This opens possibilities to further meet the demands of a shrinking organ supply, especially with regard to expanding living-donor options.

摘要

背景

ABO 不相容的器官移植通常会引起超急性排斥反应。A2 型到 O 型的肝移植已经成功。本研究基于器官获取与移植网络（Organ Procurement and Transplantation Network，OPTN）的数据，比较了 O 型受者接受 A2 型和 O 型移植物的总体和移植物存活率。

方法

使用 Scientific Registry of Transplant Recipients 数据。首例 A2 型到 O 型肝移植于 1990 年 3 月 11 日进行；排除了所有以前的移植。1990 年 3 月 11 日至 2010 年 9 月 3 日，43335 名 O 型受者接受了移植，其中 358 名受者接受了 A2 移植物。

结果

两组间在年龄、性别和种族方面无显著差异。与接受 O 移植物的受者相比，接受 A2 移植物的受者在移植时更有可能住院（45% vs. 38%，P≤0.05），并且平均（SD）终末期肝病模型评分更高（24 [11] vs. 22 [10]，P≤0.05）。10%的 A2 受者和 9%的 O 受者接受了再次移植。移植住院期间和 12 个月时的排斥反应无显著差异：A2 受者和 O 受者分别为 7%和 6%，20%和 22%；移植物衰竭的促成因素或死亡原因也无显著差异。5 年时，A2 移植物和 O 移植物受者的总存活率分别为 77%和 74%（对数秩检验=0.71）。5 年时，两组的移植物存活率均为 66%（对数秩检验=0.52）。Cox 回归分析显示供体血型对总体和移植物存活率无显著影响。

结论

本研究使用 OPTN/Scientific Registry of Transplant Recipients 数据，提供了最大的 A2 型到 O 型肝移植系列，并得出这种不匹配方案是安全的，具有相似的总体和移植物存活率。这为进一步满足不断缩小的器官供应需求提供了可能性，特别是在扩大活体供者选择方面。