Shen Tian, Lin Bing-Yi, Jia Jun-Jun, Wang Zhuo-Yi, Wang Li, Ling Qi, Geng Lei, Yan Sheng, Zheng Shu-Sen
Key Lab of Combined Multi-organ Transplantation, Ministry of Public Health, Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2014 Aug;13(4):395-401. doi: 10.1016/s1499-3872(14)60268-x.
The established procedure for ABO-incompatible liver transplantation (ABO-I LT) was too complicated to be used in case of emergency. We developed a protocol consisting of rituximab and intravenous immunoglobulin (IVIG) for ABO-I LT in patients with acute liver failure (ALF).
The data from 101 patients who had undergone liver transplantation (LT) for ALF were retrospectively analyzed. The patients were divided into two groups: ABO-compatible liver transplantation group (ABO-C LT, n=66) and ABO-I LT group (n=35). All the patients in the ABO-I LT group received a single dose of rituximab (375 mg/m2) and IVIG (0.4 g/kg per day) at the beginning of the operation. IVIG was administered for 10 consecutive days after LT. Plasma exchange, splenectomy and graft local infusion were omitted in the protocol. Quadruple immunosuppressive therapy including basiliximab, corticosteroids, tacrolimus and mycophenolatemofetil was used to reinforce immunosuppression.
The 3-year cumulative patient survival rates in the ABO-I LT and ABO-C LT groups were 83.1% and 86.3%, respectively (P>0.05), and the graft survival rates were 80.0% and 86.3%, respectively (P>0.05). Two patients (5.7%) suffered from antibody-mediated rejection in the ABO-I LT group. Other complications such as acute cellular rejection, biliary complication and infection displayed no significant differences between the two groups.
The simplified treatment consisting of rituximab and IVIG prevented antibody-mediated rejection for LT of blood-type incompatible patients. With this treatment, the patients did not need plasma exchange, splenectomy and graft local infusion. This treatment was safe and efficient for LT of the patients with ALF.
已确立的ABO血型不相容肝移植（ABO-I LT）程序过于复杂，难以用于紧急情况。我们制定了一项由利妥昔单抗和静脉注射免疫球蛋白（IVIG）组成的方案，用于急性肝衰竭（ALF）患者的ABO-I LT。
回顾性分析101例因ALF接受肝移植（LT）患者的数据。患者分为两组：ABO血型相容肝移植组（ABO-C LT，n = 66）和ABO-I LT组（n = 35）。ABO-I LT组的所有患者在手术开始时接受单剂量利妥昔单抗（375 mg/m²）和IVIG（每天0.4 g/kg）。LT后连续10天给予IVIG。该方案中省略了血浆置换、脾切除术和移植物局部输注。使用包括巴利昔单抗、皮质类固醇、他克莫司和霉酚酸酯的四联免疫抑制疗法加强免疫抑制。
ABO-I LT组和ABO-C LT组的3年累积患者生存率分别为83.1%和86.3%（P>0.05），移植物生存率分别为80.0%和86.3%（P>0.05）。ABO-I LT组有2例患者（5.7%）发生抗体介导的排斥反应。两组之间急性细胞排斥、胆道并发症和感染等其他并发症无显著差异。
由利妥昔单抗和IVIG组成的简化治疗可预防血型不相容患者肝移植的抗体介导排斥反应。采用这种治疗方法，患者无需进行血浆置换、脾切除术和移植物局部输注。该治疗方法对ALF患者的肝移植安全有效。
