Lee Wei-Chen, Cheng Chih-Hsien, Lee Chen-Fang, Hung Hao-Chien, Lee Jin-Chiao, Wu Tsung-Han, Wang Yu-Chao, Wu Ting-Jung, Chou Hong-Shiue, Chan Kun-Ming
Division of Liver and Transplantation Surgery, Department of General Surgery, Chang-Gung Memorial Hospital, Linkou, Taiwan.
Chang-Gung University College of Medicine, Taoyuan, Taiwan.
Clin Transplant. 2022 Mar;36(3):e14555. doi: 10.1111/ctr.14555. Epub 2022 Jan 17.
Acute liver failure is life-threatening and has to be treated by liver transplantation urgently. When deceased donors or ABO-compatible living donors are not available, ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) becomes the only choice. How to prepare ABO-I LDLT urgently is an unsolved issue. A quick preparation regimen was designed, which was consisted of bortezomib (3.5 mg) injection to deplete plasma cells and plasma exchange to achieve isoagglutinin titer ≤ 1: 64 just prior to liver transplantation and followed by rituximab (375 mg/m ) on post-operative day 1 to deplete B-cells. Eight patients received this quick preparation regimen to undergo ABO-I LDLT for acute liver failure from 2012 to 2019. They aged between 50 and 60 years. The median MELD score was 39 with a range from 35 to 48. It took 4.75 ± 1.58 days to prepare such an urgent ABO-I LDLT. All the patients had successful liver transplantations, but one patient died of antibody-mediated rejection at post-operative month 6. The 3-month, 6-month, and 1-year graft/patient survival were 100%, 87.5%, and 75%, respectively. In conclusion, this quick preparation regimen can reduce isoagglutinin titers quickly and make timely ABO-I LDLT feasible for acute liver failure.
急性肝衰竭危及生命，必须紧急进行肝移植治疗。当无法获得脑死亡供体或ABO血型相容的活体供体时，ABO血型不相容（ABO-I）活体供肝移植（LDLT）就成为唯一选择。如何紧急准备ABO-I LDLT是一个尚未解决的问题。我们设计了一种快速准备方案，即在肝移植前用硼替佐米（3.5mg）注射以清除浆细胞，并进行血浆置换以使同种凝集素效价≤1:64，然后在术后第1天给予利妥昔单抗（375mg/m²）以清除B细胞。2012年至2019年，8例患者接受了这种快速准备方案，进行ABO-I LDLT治疗急性肝衰竭。他们的年龄在50至60岁之间。中位终末期肝病模型（MELD）评分39分，范围为35至48分。准备如此紧急的ABO-I LDLT需要4.75±1.58天。所有患者肝移植均成功，但1例患者在术后6个月死于抗体介导的排斥反应。3个月、6个月和1年的移植物/患者生存率分别为100%、87.5%和75%。总之，这种快速准备方案可快速降低同种凝集素效价，使急性肝衰竭患者能及时进行ABO-I LDLT。
