Yu Se-Hyeon, Jo Hye-Sung, Yu Young-Dong, Park Pyoung-Jae, Han Hyung-Joon, Kim Sang-Jin, Kamarulzaman Syahrul Hadi, Kim Dong-Sik
Division of HBP Surgery and Liver Transplantation, Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea.
Division of Transplantation and Vascular Surgery, Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea.
J Clin Med. 2024 Aug 14;13(16):4789. doi: 10.3390/jcm13164789.
Although advancements in desensitization protocols have led to increased ABO-incompatible (ABOi) living-donor liver transplantation (LDLT), a higher biliary complication rate remains a problem. This study evaluated the effect of baseline anti-ABO antibody titers before desensitization on biliary complications after ABOi LDLT. The study cohort comprised 116 patients in the ABO-compatible group (ABOc), 29 in the ABOi with the low titer (<1:128) group (ABOi-L), and 14 in the high titer (≥1:128) group (ABOi-H). Biliary complications occurred more frequently in the ABOi-H group than in the ABOi-L and ABOc groups (7 [50.0%] vs. 8 [27.6%] and 24 [20.7%], respectively, = 0.041). Biliary complication-free survival was significantly worse in the ABOi-H group than in the other groups ( = 0.043). Diffuse intrahepatic biliary strictures occurred more frequently in the ABOi-H group than in the other groups ( = 0.005). Multivariable analysis revealed that the high anti-ABO antibody titer (≥1:128) is an independent risk factor for biliary complications (hazard ratio 3.943 [1.635-9.506]; = 0.002). A high baseline anti-ABO antibody titer (≥1:128), female sex, and hepatic artery complications are significant risk factors for biliary complications.
尽管脱敏方案的进展已使ABO血型不相容（ABOi）活体肝移植（LDLT）有所增加，但较高的胆道并发症发生率仍是一个问题。本研究评估了脱敏前基线抗ABO抗体滴度对ABOi LDLT术后胆道并发症的影响。研究队列包括116例ABO血型相容组（ABOc）患者、29例低滴度（<1:128）ABOi组（ABOi-L）患者和14例高滴度（≥1:128）组（ABOi-H）患者。ABOi-H组胆道并发症的发生频率高于ABOi-L组和ABOc组（分别为7例[50.0%]、8例[27.6%]和24例[20.7%]，P = 0.041）。ABOi-H组无胆道并发症生存率明显低于其他组（P = 0.043）。ABOi-H组弥漫性肝内胆管狭窄的发生频率高于其他组（P = 0.005）。多变量分析显示，高抗ABO抗体滴度（≥1:128）是胆道并发症的独立危险因素（风险比3.943[1.635 - 9.506]；P = 0.002）。高基线抗ABO抗体滴度（≥1:128）、女性性别和肝动脉并发症是胆道并发症的重要危险因素。
