Lee Hyun-Ji, Shin Kyung-Hwa, Song Duyeal, Lee Sun-Min, Chang Chulhun L, Chu Chong Woo, Ryu Je Ho, Lee Tae Bum, Park Yong-Mok, Yang Kwang Ho, Choi Byung Hyun, Kim Hyung-Hoi
Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Yangsan Hospital, Republic of Korea.
Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Republic of Korea.
Transfus Apher Sci. 2017 Jun;56(3):385-388. doi: 10.1016/j.transci.2017.03.001. Epub 2017 Mar 18.
Therapeutic plasma exchange (TPE) is used for temporary support of liver function in patients presenting with early graft dysfunction after liver transplantation (LT) or liver surgery. We analyzed the effect of therapeutic apheresis on patients with liver disease.
Between January 2011 and August 2016, 93 apheresis procedures were performed for 26 patients at our institution. Anti-ABO isoagglutination immunoglobulin (Ig) M titer was checked using a type A and type B 3% red blood cell (RBC) suspension in saline with two-fold serial dilutions of patient serum. Anti-ABO isoagglutination IgG titer was checked by a type A and B 0.8% RBC suspension using a low-ionic strength/Coombs card.
ABO-incompatible (ABOi) LT was the most common (n=10, 38.5%) indication for apheresis; early graft dysfunction after LT (n=8, 30.7%) was the second most common. Median initial IgM and IgG anti-ABO titers for ABOi LT recipients were 1:16 (range, 1:8-1:128) and 1:48 (range, 1:8-1:2048). We performed preoperative TPE in 10 recipients (median number of sessions, 1.5; range, 1-11). Among patients with early graft dysfunction, those who underwent living donor LT had better survival (4/4; 100%) than those who underwent nonliving donor LT (0/3; 0%). Patients who underwent living donor LT first and then additional LT also survived after three TPE sessions.
Therapeutic apheresis is associated with a good survival rate and is essential for liver support in patients with early graft dysfunction after LT or posthepatectomy liver failure and during preparation for ABOi LT.
治疗性血浆置换（TPE）用于肝移植（LT）或肝脏手术后出现早期移植物功能障碍患者的肝功能临时支持。我们分析了治疗性血液成分分离术对肝病患者的影响。
2011年1月至2016年8月期间，我们机构对26例患者进行了93次血液成分分离术。使用A型和B型3%红细胞（RBC）生理盐水悬液对患者血清进行两倍连续稀释，检测抗ABO同种凝集免疫球蛋白（Ig）M滴度。使用低离子强度/抗人球蛋白试验卡，通过A型和B型0.8%红细胞悬液检测抗ABO同种凝集IgG滴度。
ABO血型不相容（ABOi）肝移植是血液成分分离术最常见的适应证（n = 10，38.5%）；肝移植后早期移植物功能障碍（n = 8，30.7%）是第二常见的适应证。ABOi肝移植受者的初始IgM和IgG抗ABO滴度中位数分别为1:16（范围，1:8 - 1:128）和1:48（范围，1:8 - 1:2048）。我们对10例受者进行了术前TPE（疗程中位数，1.5；范围，1 - 11）。在早期移植物功能障碍患者中，接受活体供肝肝移植的患者生存率（4/4；100%）高于接受尸体供肝肝移植的患者（0/3；0%）。先接受活体供肝肝移植然后再接受其他肝移植的患者在进行三次TPE疗程后也存活下来。
治疗性血液成分分离术与良好的生存率相关，对于肝移植后早期移植物功能障碍或肝切除术后肝衰竭患者以及ABOi肝移植准备期间的肝脏支持至关重要。
