小儿 ABO 不相容活体相关供肝肝移植：来自印度次大陆的经验。

Pediatric ABO-incompatible Living Related Donor Liver Transplantation: Experience from Indian Subcontinent.

机构信息

Department of Pediatric Gastroenterology and Hepatology, Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana, India.

Pediatric Critical Care, Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana, India.

出版信息

Indian Pediatr. 2021 Mar 15;58(3):281-282.

PMID:33713067

Abstract

We present our experience with pediatric ABO-incompatible liver transplantation in India. Data of patients <18 years of age undergoing ABO-incompatible liver transplantation our hospital between January, 2011 and November, 2018 were analyzed. Plasmapheresis was done pre-transplant till antibody titer was <16 units. Rituximab/Intravenous immunoglobulin was used for immunosuppression, in addition to standard drugs (mycophenolate mofetil, steroids, and tacrolimus). Out of 203 patients that underwent liver transplant during this period, 8 underwent ABO-incompatible liver transplantation; 4 (3 boys) had blood group O+ve. Median (range) age was 28 (7-91) mo, PELD score was 24.5 (14-42), and pre-transplant antibody titer range was 1:32-1024. Number of plasmapheresis sessions required ranged from 1-6. Post-operatively two patients had rise in antibody titer >64 requiring plasmapheresis. All 8 patients survived without rejection/biliary issues. Mean (range) of post-transplant hospital stay was 19.1 (13-22) d and follow-up period was 38.1 (7.1-84.4) mo. Pediatric ABO-incompatible liver transplantation can be successfully performed using plasmapheresis with optimal immune-suppression and vigilant post-op monitoring.

摘要

我们介绍了在印度进行小儿 ABO 不相容肝移植的经验。分析了 2011 年 1 月至 2018 年 11 月期间在我院接受 ABO 不相容肝移植的年龄<18 岁的患者数据。在移植前，我们一直进行血浆置换，直到抗体滴度降至<16 单位。我们使用利妥昔单抗/静脉注射免疫球蛋白进行免疫抑制，此外还使用了标准药物（霉酚酸酯、皮质类固醇和他克莫司）。在这段时间内，203 名患者接受了肝移植，其中 8 名患者接受了 ABO 不相容肝移植；4 名（3 名男孩）的血型为 O+ve。中位（范围）年龄为 28（7-91）mo，PELD 评分为 24.5（14-42），移植前抗体滴度范围为 1:32-1024。所需的血浆置换次数从 1 到 6 不等。术后有 2 名患者的抗体滴度升高至>64，需要进行血浆置换。所有 8 名患者均未发生排斥/胆道问题而存活。移植后平均（范围）住院时间为 19.1（13-22）天，随访期为 38.1（7.1-84.4）月。小儿 ABO 不相容肝移植可以通过血浆置换与最佳免疫抑制和术后监测相结合成功进行。