Lemoine Caroline P, Brandt Katherine A, Keswani Mahima, Superina Riccardo
Division of Transplant and Advanced Hepatobiliary Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Division of Nephrology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
Front Pediatr. 2023 May 31;11:1092412. doi: 10.3389/fped.2023.1092412. eCollection 2023.
ABO incompatible (ABOi) liver transplantation (LT) was initially associated with a higher incidence of vascular, biliary, and rejection complications and a lower survival than ABO compatible (ABOc) LT. Various protocols have been proposed to manage anti-isohemagglutinin antibodies and hyperacute rejection. We present our experience with a simplified protocol using only plasmapheresis.
A retrospective review of all patients who received an ABOi LT at our institution was performed. Comparisons were made based on era (early: 1997-2008, modern: 2009-2020) and severity of disease (status 1 vs. exception PELD at transplant). A pair-matched comparison was done to patients who received an ABOc LT. < 0.05 was considered significant.
17 patients received 18 ABOi LT (3 retransplants). Median age at transplant was 7.4 months (1.1-28.9). 66.7% patients were listed as status 1. Hepatic artery thrombosis (HAT) occurred in one patient (5.6%), there were 2 cases of portal vein thrombosis (PVT) (11.1%), and 2 biliary strictures (11.1%). Patient and graft survival improved in the ABOi modern era, although not significantly. In the pair-matched comparison, complications (HAT = 0.29; PVT = 0.37; biliary complications = 0.15) and survival rates were similar. Patient and graft survivals were 100% in the non-status 1 ABOi patients compared to 67% ( = 0.11) and 58% ( = 0.081) respectively for patients who were transplanted as status 1.
ABO incompatible liver transplants in infants with a high PELD score have excellent outcomes. Indications for ABO incompatible transplants should be liberalized to prevent deaths on the waiting list or deterioration of children with high PELD scores.
ABO血型不相容（ABOi）肝移植（LT）最初与血管、胆道和排斥反应并发症的发生率较高以及生存率低于ABO血型相容（ABOc）肝移植有关。已经提出了各种方案来处理抗同种血凝素抗体和超急性排斥反应。我们介绍了仅使用血浆置换的简化方案的经验。
对在我们机构接受ABOi肝移植的所有患者进行回顾性研究。根据时代（早期：1997 - 2008年，现代：2009 - 2020年）和疾病严重程度（移植时状态1与例外PELD）进行比较。对接受ABOc肝移植的患者进行配对比较。P < 0.05被认为具有统计学意义。
17例患者接受了18次ABOi肝移植（3例再次移植）。移植时的中位年龄为7.4个月（1.1 - 28.9个月）。66.7%的患者被列为状态1。1例患者发生肝动脉血栓形成（HAT）（5.6%），2例门静脉血栓形成（PVT）（11.1%），2例胆道狭窄（11.1%）。ABOi现代时代的患者和移植物生存率有所提高，尽管不显著。在配对比较中，并发症（HAT = 0.29；PVT = 0.37；胆道并发症 = 0.15）和生存率相似。非状态1的ABOi患者的患者和移植物生存率为100%，而移植时为状态1的患者分别为67%（P = 0.11）和58%（P = 0.081）。
高PELD评分婴儿的ABO血型不相容肝移植具有良好的结果。ABO血型不相容移植的适应证应放宽，以防止等待名单上的死亡或高PELD评分儿童的病情恶化。
