de Magnée Catherine, Brunée Louise, Tambucci Roberto, Pire Aurore, Scheers Isabelle, Sokal Etienne M, Baldin Pamela, Zech Francis, Eeckhoudt Stéphane, Reding Raymond, Stephenne Xavier
Pediatric Surgery and Transplantation Unit, Cliniques Universitaires St Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium.
Pediatric Gastroenterology and Hepatology Division, Cliniques Universitaires St Luc, 1200 Brussels, Belgium.
Children (Basel). 2021 Jul 16;8(7):600. doi: 10.3390/children8070600.
ABO-incompatible (ABOi) living donor liver transplantation (LDLT) has been proposed to compensate for donor shortage. To date, few studies have reported detailed ABOi LDLT results in large series of pediatric patients. C4d complement deposition in graft capillaries has been reported to be associated with antibody-mediated rejection in solid organ transplantation.
A retrospective case-control study was conducted, comparing clinical outcomes of each of 34 consecutive pediatric ABOi LDLT recipients with those of 2 non-ABOi pairs ( = 68), matched according to pre-transplant diagnostic criteria, age, and date of transplantation. In addition, we studied the C4d immunostaining pattern in 22 ABOi and in 36 non-ABOi recipients whose liver biopsy was performed within the first 4 post-transplant weeks for suspected acute rejection.
The incidence of biliary complications was higher in ABOi recipients ( < 0.05), as were the incidence of acute humoral rejection ( < 0.01) and the incidence of retransplantation ( < 0.05). All children who required retransplantation were older than 1 year at the time of ABOi LDLT. Positive C4d immunostaining was observed in 13/22 (59%) ABOi recipients versus 3/36 (8.3%) non-ABOi recipients ( < 0.0001).
ABOi LDLT is a feasible option for pediatric end-stage liver disease but carries increased risks for the recipient, especially for children older than 1 year, even with a specific preparation protocol. C4d immunostaining may be a hallmark of acute humoral rejection in ABOi liver transplantation.
ABO血型不相容（ABOi）的活体供肝肝移植（LDLT）已被提出用于弥补供体短缺。迄今为止，很少有研究报道大量儿科患者的详细ABOi LDLT结果。据报道，移植肝毛细血管中的C4d补体沉积与实体器官移植中的抗体介导排斥反应有关。
进行了一项回顾性病例对照研究，比较了34例连续的儿科ABOi LDLT受者与2例非ABOi配对受者（n = 68）的临床结局，根据移植前诊断标准、年龄和移植日期进行匹配。此外，我们研究了22例ABOi受者和36例非ABOi受者的C4d免疫染色模式，这些受者在移植后前4周内因疑似急性排斥反应而进行了肝活检。
ABOi受者的胆道并发症发生率更高（P < 0.05），急性体液排斥反应发生率（P < 0.01）和再次移植发生率（P < 0.05）也是如此。所有需要再次移植 的儿童在进行ABOi LDLT时年龄均超过1岁。13/22（59%）的ABOi受者观察到C4d免疫染色阳性，而非ABOi受者为3/36（8.3%）（P < 0.0001）。
ABOi LDLT是小儿终末期肝病的一种可行选择，但对受者来说风险增加，尤其是对1岁以上的儿童，即使采用特定的预处理方案也是如此。C4d免疫染色可能是ABOi肝移植中急性体液排斥反应的一个标志。
