Hosaagrahara Ramakrishna Somashekara, Kasala Mohan Babu, Perumal Karnan, Malleeswaran Selvakumar, Patcha Rajanikanth V, Varghese Joy, Sathiyasekaran Malathy, Reddy Mettu Srinivas
Department of Pediatric Hepatology, Gleneagles Global Health City, Perumbakkam, Chennai, India.
Department of Pediatric Intensive Care, Gleneagles Global Health City, Perumbakkam, Chennai, India.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):658-663. doi: 10.1016/j.jceh.2021.08.008. Epub 2021 Aug 21.
ABO-incompatible living donor liver transplantation (ABOi-LDLT) is on the rise as a viable option in countries with limited access to deceased donor grafts. While reported outcomes of ABOi-LT in children are similar to ABO- Compatible liver transplant (ABOc-LT), most children beyond 1-2 years of age will need desensitization to overcome the immunological barrier of incompatible blood groups. The current standard protocol for desensitization is Rituximab that targets B lymphocytes and is given 2-3 weeks prior to LT. However, this timeline may not be feasible in children requiring emergency LT for acute liver failure (ALF) or acute-on-chronic liver failure (ACLF). In this emergency situation of ABOi-LT, a safe multipronged approach may be an acceptable alternative solution. We report a child with acute Wilson's disease with rapidly deteriorating liver function who underwent a successful ABOi-LDLT using a rapid desensitization protocol.
在尸体供肝获取受限的国家，ABO血型不相容的活体肝移植（ABOi-LDLT）作为一种可行的选择正在兴起。虽然儿童ABOi-LT的报告结果与ABO血型相容肝移植（ABOc-LT）相似，但大多数1-2岁以上的儿童需要进行脱敏以克服血型不相容的免疫屏障。目前脱敏的标准方案是利妥昔单抗，它靶向B淋巴细胞，在肝移植前2-3周给药。然而，对于因急性肝衰竭（ALF）或慢加急性肝衰竭（ACLF）需要紧急肝移植的儿童，这个时间安排可能不可行。在ABOi-LT这种紧急情况下，一种安全的多管齐下的方法可能是一种可接受的替代解决方案。我们报告了一名患有急性威尔逊病且肝功能迅速恶化的儿童，该儿童采用快速脱敏方案成功进行了ABOi-LDLT。
