Kim J D, Choi D L, Kim S-G, Lee A-J
Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Catholic University of Daegu, School of Medicine, Daegu, Korea.
Division of Hepatobiliary Pancreas Surgery and Abdominal Organ Transplantation, Department of Surgery, Catholic University of Daegu, School of Medicine, Daegu, Korea.
Transplant Proc. 2016 May;48(4):1134-8. doi: 10.1016/j.transproceed.2016.02.040.
The outcomes of patients who undergo ABO-incompatible (ABO-I) living-donor liver transplantation (LDLT) have markedly improved as strategies have become more innovative and advanced. Here, we describe 25 cases of ABO-I LDLT with a simplified protocol and compare the outcomes to those of ABO-compatible LDLT. We analyzed outcomes via a retrospective review of 182 adult LDLT cases including 25 ABO-I LDLTs from January 2011 to December 2014. Propensity scoring was used to compare the groups. The desensitization protocol included plasma exchange, rituximab, and intravenous immunoglobulin without local infusion therapy. The triple immunosuppression protocol consisted of tacrolimus and steroids with mycophenolate mofetil; a splenectomy was not routinely performed. The median age of recipients was 51 years (range, 35-66 years), and the median mean Model for End-Stage Liver Disease (MELD) score was 15 (range, 7-37). The initial ranges of isoagglutinin IgM and IgG titers were 1:1 to 1:256 and 1:4 to 1:2048, respectively. There were no significant differences in patient demographics or perioperative variables between the groups. Although significant rebound elevation in anti-ABO antibody during the postoperative period was observed in 3 cases, neither C4d staining nor clinical signs of antibody-mediated rejection was apparent in these cases. No diffuse intrahepatic biliary stricture was encountered in any ABO-I LDLT patient within a mean follow-up of 22.6 ± 17.2 months. Moreover, no significant difference in overall or graft survival was observed between the groups. ABO-I LDLT can be performed safely under this new simplified protocol and may be proposed when ABO-compatible donors are unavailable.
随着策略变得更加创新和先进，接受ABO血型不相容（ABO-I）活体肝移植（LDLT）患者的预后有了显著改善。在此，我们描述了25例采用简化方案的ABO-I LDLT病例，并将其结果与ABO血型相容的LDLT结果进行比较。我们通过回顾性分析2011年1月至2014年12月期间182例成人LDLT病例（包括25例ABO-I LDLT）来分析结果。采用倾向评分法对各组进行比较。脱敏方案包括血浆置换、利妥昔单抗和静脉注射免疫球蛋白，不进行局部输注治疗。三联免疫抑制方案由他克莫司、类固醇和霉酚酸酯组成；未常规进行脾切除术。受者的中位年龄为51岁（范围35 - 66岁），终末期肝病模型（MELD）评分中位数为15（范围7 - 37）。同种凝集素IgM和IgG滴度的初始范围分别为1:1至1:256和1:4至1:2048。两组之间患者人口统计学或围手术期变量无显著差异。虽然3例患者术后观察到抗ABO抗体有显著的反弹升高，但这些病例中均未出现C4d染色或抗体介导排斥反应的临床体征。在平均22.6±17.2个月的随访中，任何ABO-I LDLT患者均未出现弥漫性肝内胆管狭窄。此外，两组之间在总体生存率或移植物生存率方面未观察到显著差异。在这种新的简化方案下，ABO-I LDLT可以安全进行，并且在没有ABO血型相容供体时可以考虑采用。
