Han Cheng-Zuo, Wei Qiang, Yang Meng-Fan, Zhuang Li, Xu Xiao
Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China.
Department of Hepatobiliary and Pancreatic Surgery, The Center for Integrated Oncology and Precision Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China; Institute of Organ Transplantation, Zhejiang University, Hangzhou 310003, China; National Center for Healthcare Quality Management in Liver Transplant, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2022 Dec;21(6):538-542. doi: 10.1016/j.hbpd.2022.06.019. Epub 2022 Jul 4.
The shortage of donor liver restricts liver transplantation (LT). Nowadays, donor liver with ABO blood group incompatibility between donor and recipient has become an option to expand the source of donor liver. Although it is now possible to perform ABO-incompatible (ABO-I) LT, antibody-mediated rejection (AMR) has been recognized as the primary cause of desperate outcomes after ABO-I LT. Anti-A/B antibody is the trigger of immune response to ABO-I LT graft injury. Therapeutic plasma exchange (TPE) can quickly reduce the titer of plasma antibodies and effectively inhibit humoral immunity.
We searched PubMed and CNKI databases using search terms "therapeutic plasma exchange", "ABO-incompatible liver transplantation", "ABO-I LT", "liver transplantation", "LT", "antibody-mediated rejection", and "AMR". Additional publications were identified by a manual search of references from key articles. The relevant publications published before September 30, 2020 were included in this review.
Different centers have made different attempts on whether to use TPE, when to use TPE and how often to use TPE. However, the control standard of lectin revision level is always controversial, the target titer varies significantly from center to center, and the standard target titer has not yet been established. TPE has several schemes to reduce antibody titers, but there is a lack of clinical trials that provide standardized procedures.
TPE is essential for ABO-I LT. Hence, further research and clinical trials should be conducted to determine the best regimen for TPE to remove ABO antibodies and prevent AMR.
供肝短缺限制了肝移植（LT）。如今，供受者之间ABO血型不相容的供肝已成为扩大供肝来源的一种选择。尽管现在可以进行ABO血型不相容（ABO-I）肝移植，但抗体介导的排斥反应（AMR）已被认为是ABO-I肝移植后出现严重后果的主要原因。抗A/B抗体是引发对ABO-I肝移植移植物损伤免疫反应的因素。治疗性血浆置换（TPE）可迅速降低血浆抗体滴度并有效抑制体液免疫。
我们使用搜索词“治疗性血浆置换”“ABO血型不相容肝移植”“ABO-I肝移植”“肝移植”“LT”“抗体介导的排斥反应”和“AMR”在PubMed和中国知网数据库中进行了检索。通过手动检索关键文章的参考文献确定了其他出版物。纳入本综述的是2020年9月30日前发表的相关出版物。
不同中心在是否使用TPE、何时使用TPE以及使用TPE的频率上进行了不同尝试。然而，凝集素校正水平的控制标准一直存在争议，不同中心的目标滴度差异很大，尚未确立标准的目标滴度。TPE有多种降低抗体滴度的方案，但缺乏提供标准化程序的临床试验。
TPE对ABO-I肝移植至关重要。因此，应开展进一步的研究和临床试验，以确定TPE去除ABO抗体和预防AMR的最佳方案。
