Yandza T, Lambert T, Alvarez F, Gauthier F, Jacolot D, Huault G, Fabre M, Valayer J
Department of Pediatric Surgery, Hôpital Bicetre, Le Kremlin-Bicêtre, France.
Transplantation. 1994 Jul 15;58(1):46-50.
The shortage of suitable liver donors for children has motivated the use of ABO-incompatible (ABO-I) grafts for transplantation in urgent situations. However, survival after ABO-I liver grafts has been reported at about 30% as compared with 80% in cases of ABO-identical or -compatible liver grafts. This difference has been attributed to antibody-mediated, hyperacute or chronic liver rejection, due to preformed ABO antibodies (alloantibodies). In this study, we report our results with ABO-I livers in children without alloantibodies at the time of transplantation. From January 1988 to June 1993, 143 OLT were performed in 122 children. Eight children received 8 ABO-I liver grafts. Of these, 7 patients were included in the study. All 7 were alloantibody free before OLT. Five children were spontaneously alloantibody free, while in 2 children, the plasma alloantibodies were eliminated before and after transplantation using intravenous infusion of specific blood group antigens of the donor blood group (soluble antigens). Immunosuppression consisted of a triple-drug treatment combining CsA, AZA, and steroids. The follow-up period was between 10 and 48 months. One child died from a surgical complication. Six children survived, but 1 died 10 months later from intestinal obstruction. There were no graft losses and no episodes of hyperacute or chronic rejection. The graft and patient survival rate was 71%. There was a 28% incidence of rejection, but all were mild (requiring steroid boluses only). Our results suggest that the absence of ABO alloantibodies at the time of and after transplantation can protect ABO-I liver grafts against antibody-mediated rejection, whether hyperacute or chronic, and that soluble antigens are effective in eliminating alloantibodies in children.
儿童合适肝脏供体的短缺促使人们在紧急情况下使用ABO血型不相容（ABO-I）移植物进行移植。然而，据报道，ABO-I肝脏移植后的存活率约为30%，而ABO血型相同或相容的肝脏移植存活率为80%。这种差异归因于预先形成的ABO抗体（同种抗体）介导的抗体介导的超急性或慢性肝脏排斥反应。在本研究中，我们报告了在移植时没有同种抗体的儿童中使用ABO-I肝脏的结果。从1988年1月至1993年6月，对122名儿童进行了143例原位肝移植。8名儿童接受了8例ABO-I肝脏移植。其中，7例患者被纳入研究。所有7例在肝移植前均无同种抗体。5名儿童自然无同种抗体，而在2名儿童中，在移植前后通过静脉输注供体血型的特异性血型抗原（可溶性抗原）消除了血浆同种抗体。免疫抑制采用环孢素、硫唑嘌呤和类固醇联合的三联药物治疗。随访期为10至48个月。1名儿童死于手术并发症。6名儿童存活，但1名在10个月后死于肠梗阻。没有移植物丢失，也没有超急性或慢性排斥反应发作。移植物和患者存活率为71%。排斥反应发生率为28%，但均为轻度（仅需大剂量类固醇）。我们的结果表明，移植时和移植后不存在ABO同种抗体可保护ABO-I肝脏移植物免受抗体介导的排斥反应，无论是超急性还是慢性排斥反应，并且可溶性抗原在消除儿童同种抗体方面是有效的。
