Peruhova Milena, Georgieva Viktoriya, Yurukova Nonka, Sekulovska Monika, Panayotova Gabriela, Mihova Antoaneta, Terzieva Velislava, Velikova Tsvetelina Veselinova
Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria.
Department of Clinical Immunology, University Hospital Lozenetz, Sofia 1407, Bulgaria.
World J Transplant. 2020 May 29;10(5):138-146. doi: 10.5500/wjt.v10.i5.138.
Although ABO-nonidentical and ABO-incompatible liver transplantation (LT) are other options for end-stage liver disease treatment, the development of antibodies against blood group antigens (anti-A/B antibodies) is still a challenge in managing and follow-up of the recipients.
A 56-year-old male with end-stage liver disease with rapid deterioration and poor prognosis was considered to receive a deceased ABO-nonidentical liver graft. All required tests were performed according to our pre-LT diagnostic protocol. The orthotopic LT procedure involving O+ donor and A1B+ recipient was performed. Our treatment strategy to overcome the antibody-mediated rejection included a systemic triple immunosuppressive regimen: methylprednisolone, mycophenolate mofetil, and tacrolimus. The immunological desensitization consisted of the chimeric anti-CD20 monoclonal antibody rituximab and intravenous immunoglobulins. The patient was also on antibiotic treatment with amoxicillin/clavulanate, cefotaxime, and metronidazole. On the 10 postoperative day, high titers of IgG anti-A and anti-B antibodies were found in the patient's plasma. We performed a liver biopsy, which revealed histological evidence of antibody-mediated rejection, but the rejection was excluded according to the Banff classification. The therapy was continued until the titer decreased significantly on the 18 postoperative day. Despite the antibiotic, antifungal, and antiviral treatment, the patient deteriorated and developed septic shock with anuria and pancytopenia. The conservative treatment was unsuccessful, which lead to the patient's fatal outcome on the 42 postoperative day.
We present a patient who underwent ABO-nonidentical LT from a deceased donor. Even though we implemented the latest technological advancements and therapeutic approaches in the management of the patient and the initial results were promising, due to severe infectious complications, the outcome was fatal.
尽管ABO血型不匹配和ABO血型不相容的肝移植（LT）是终末期肝病治疗的其他选择，但在受者的管理和随访中，针对血型抗原的抗体（抗A/B抗体）的产生仍然是一个挑战。
一名56岁男性，患有终末期肝病，病情迅速恶化且预后不良，被认为适合接受已故供体的ABO血型不匹配肝移植。所有必要的检查均按照我们的肝移植前诊断方案进行。进行了原位肝移植手术，供体为O+，受体为A1B+。我们克服抗体介导排斥反应的治疗策略包括全身性三联免疫抑制方案：甲泼尼龙、霉酚酸酯和他克莫司。免疫脱敏包括嵌合抗CD20单克隆抗体利妥昔单抗和静脉注射免疫球蛋白。患者还接受了阿莫西林/克拉维酸、头孢噻肟和甲硝唑的抗生素治疗。术后第10天，在患者血浆中发现高滴度的IgG抗A和抗B抗体。我们进行了肝活检，结果显示有抗体介导排斥反应的组织学证据，但根据班夫分类法排除了排斥反应。治疗持续进行，直到术后第18天滴度显著下降。尽管进行了抗生素、抗真菌和抗病毒治疗，患者病情仍恶化，发展为感染性休克，出现无尿和全血细胞减少。保守治疗失败，导致患者在术后第42天死亡。
我们报告了一名接受已故供体ABO血型不匹配肝移植的患者。尽管我们在患者管理中采用了最新的技术进展和治疗方法，且初步结果令人鼓舞，但由于严重的感染并发症，结局是致命的。
