ABO血型不相容的移植物与小儿肝移植受者的良好预后相关：减少等待名单死亡率的重要资源。
ABO Incompatible Grafts Are Associated With Excellent Outcomes in Pediatric Liver Transplant Recipients: An Important Resource to Reduce Waitlist Mortality.
作者信息
Valentino Pamela L, Healey Patrick J, Perkins James D, Desai Biren, Quezada Hugo, Blondet Niviann M, Dick André A S, Gimferrer Idoia, Horslen Simon P, Hsu Evelyn K, Kwon Yong K, Saarela Katelyn M, Sturdevant Mark L, Wendel Danielle, Reyes Jorge D
机构信息
Division of Gastroenterology and Hepatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
Division of Transplantation, Department of Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
出版信息
Pediatr Transplant. 2025 May;29(3):e70047. doi: 10.1111/petr.70047.
BACKGROUND
Liver transplant (LT) waitlist mortality occurs in 10% of children; innovative strategies to expand access to LT can be lifesaving.
METHODS
Outcomes of ABO incompatible (ABOi) LT performed between 1999 and 2023 at a high-volume center were compared to ABO compatible (ABOc) LT.
RESULTS
25 ABOi LT were performed among 270 LT; 72% were listed with status 1/1A/1B or a median pediatric end-stage liver disease/model for end-stage liver disease of 40 (IQR 32,41). Time on the waitlist for ABOi recipients was shorter (median 11 days [IQR 4,46]) compared to ABOc (113 days [IQR 39,252], p < 0.001). ABOi graft types were 64% technical variants (including 2 living donor grafts) and 36% whole; 52% received a duct-duct biliary anastomosis. There were no statistically significant differences in 1/5/10-year patient survival [ABOi: 87,87,87% vs. ABOc: 96,94,89%, p = 0.6] or graft survival [ABOi: 87,82,82% vs. ABOc: 92,86,80%, p = 0.9]. When compared to ABOc, there were no statistically significant differences in vascular complications, bile leaks, or acute T-cell-mediated rejection with ABOi LT. Biliary strictures were diagnosed in 43% of ABOi LT and more frequently than in ABOc (20%, p = 0.0495).
CONCLUSIONS
ABOi LT can offer children on the waitlist a survival advantage through shorter waiting time. ABOi LT can be performed safely with a low rate of vascular complications similar to ABOc LT.
背景
10%的儿童在肝移植（LT）等待名单上死亡；扩大肝移植可及性的创新策略可能挽救生命。
方法
将1999年至2023年在一个高容量中心进行的ABO血型不相容（ABOi）肝移植结果与ABO血型相容（ABOc）肝移植进行比较。
结果
在270例肝移植中进行了25例ABOi肝移植；72%的患者被列为1/1A/1B状态，或小儿终末期肝病/终末期肝病模型中位数为40（四分位间距32,41）。与ABOc肝移植受者相比，ABOi肝移植受者在等待名单上的时间更短（中位数11天[四分位间距4,46]），而ABOc肝移植受者为113天[四分位间距39,252]，p<0.001）。ABOi肝移植的移植物类型中64%为技术变异型（包括2例活体供肝移植物），36%为全肝；其中52%接受了胆管-胆管吻合术。在1/5/10年患者生存率[ABOi：87%、87%、87% vs. ABOc：96%、94%、89%，p = 0.6]或移植物生存率[ABOi：87%、82%、82% vs. ABOc：92%、86%、80%，p = 0.9]方面无统计学显著差异。与ABOc肝移植相比，ABOi肝移植在血管并发症、胆漏或急性T细胞介导的排斥反应方面无统计学显著差异。43%的ABOi肝移植被诊断出胆管狭窄，且比ABOc肝移植更频繁（20%，p = 0.0495）。
结论
ABOi肝移植可通过缩短等待时间为等待名单上的儿童提供生存优势。ABOi肝移植可以安全进行，血管并发症发生率低，与ABOc肝移植相似。
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