Organ Transplantation Center, China Medical University Hospital, Taichung, Taiwan.
Department of Surgery, China Medical University Hospital, Taichung, Taiwan.
Ann Transplant. 2020 Sep 18;25:e923502. doi: 10.12659/AOT.923502.
BACKGROUND ABO-incompatible (ABO-i) living donor liver transplantation (LDLT) is a feasible alternative for donor liver allograft in emergency situations, especially in Asia, where deceased-donor organs remain scarce. The reported outcomes of ABO-i LDLT after optimal desensitization are comparable to those of ABO-compatible LDLT. In this retrospective study, we found improved outcomes after ABO-i LDLT with a low-dose rituximab in combination with double-filtration plasmapheresis (DFPP) and prophylactic antibiotic therapy. MATERIAL AND METHODS Between January 2006 and December 2018, a total of 65 recipients underwent ABO-i LDLT surgeries at our center. The study cohort consisted of 50 recipients (Era III) who underwent ABO-i LDLT using the recently updated desensitization protocol, which included rituximab 200 mg intravenous injection once a week prior to LDLT, 4 sessions of DFPP in all patients, and prophylactic antibiotics for 3 months. RESULTS The 3-year overall survival rate achieved in ABO-i LDLT patients was 72.7% (66.6% for Era I and 33.3% for Era II patients). In the study population, 11 patients developed complications due to infection. Five of these patients (10%) died due to overwhelming sepsis. Four patients (8%) were diagnosed with multiple strictures and diffusely scattered dilatation of intrahepatic bile ducts on computed tomography, without vascular complications. Three of them had evidence of antibody-mediated rejection (AMR). CONCLUSIONS Our experience shows that the ABO-i LDLT protocol of lowered rituximab combined with pre-transplant sessions of plasmapheresis and a quadruple immunosuppressive regimen can be effective in chronic liver failure patients with clinical urgency in the absence of an ABO-compatible donor. Fast-tracking the use of ABO-i LDLT is feasible in patients with an acute liver failure (ALF) and can safely increase the donor liver pool, with an acceptable outcome.
背景 ABO 不相容（ABO-i）活体肝移植（LDLT）是一种在紧急情况下替代供体肝移植物的可行选择，尤其是在亚洲，那里的死亡供体器官仍然稀缺。经过最佳脱敏后，ABO-i LDLT 的报告结果与 ABO 相容 LDLT 相当。在这项回顾性研究中，我们发现使用低剂量利妥昔单抗联合双重滤过血浆置换（DFPP）和预防性抗生素治疗后，ABO-i LDLT 的结果得到了改善。
2006 年 1 月至 2018 年 12 月，共有 65 名受者在我们中心接受 ABO-i LDLT 手术。研究队列由 50 名接受者（Era III）组成，他们使用最近更新的脱敏方案进行 ABO-i LDLT，该方案包括在 LDLT 前每周静脉注射利妥昔单抗 200mg 一次、所有患者进行 4 次 DFPP 和 3 个月的预防性抗生素治疗。
ABO-i LDLT 患者的 3 年总生存率为 72.7%（Era I 为 66.6%，Era II 为 33.3%）。在研究人群中，11 名患者因感染而发生并发症。其中 5 名患者（10%）因败血症合并感染而死亡。4 名患者（8%）被诊断为 CT 显示多发狭窄和肝内胆管弥漫性扩张，但无血管并发症。其中 3 例有抗体介导排斥反应（AMR）的证据。
我们的经验表明，降低利妥昔单抗剂量并结合移植前血浆置换和四重免疫抑制方案的 ABO-i LDLT 方案可有效治疗无 ABO 相容供体的慢性肝功能衰竭患者的临床紧急情况。在急性肝衰竭（ALF）患者中快速采用 ABO-i LDLT 是可行的，并且可以安全地增加供体肝脏储备，获得可接受的结果。
