• 昆明市第一人民醫(yī)院肝膽胰一科(云南昆明 650011);

目的探討ABO 血型不合肝移植的圍手術(shù)期處理模式。方法回顧性分析2006年7月至2010年5月期間我院非緊急狀態(tài)下開展的4例ABO 血型不合的肝移植患者的臨床資料。3例供體為AB型，受體為O型，均診斷乙肝肝硬變、肝功能失代償，其中1例合并重癥肝炎; 1例供體為AB型，受體為A型，診斷為原發(fā)性肝癌合并乙肝后肝硬變、肝功能失代償。結(jié)果4例均存活至今(11~19個月)，術(shù)后無感染、急性排斥反應(yīng)發(fā)生。2例術(shù)后凝血功能障礙、滲血，其中1例二次探查; 1例術(shù)后出現(xiàn)腎功能不全、少尿，給予床旁持續(xù)血漿濾過治療后恢復(fù)正常。所有病例移植肝開放血流前2 h及術(shù)后第4天均給予巴利昔單抗20 mg處理，3例同時行脾切除術(shù)，4例術(shù)后給予1周以上的丙種球蛋白靜脈滴注。血型抗體滴度術(shù)前1∶32的受體2例，術(shù)后第2天即下降并穩(wěn)定于1∶8; 術(shù)前1∶4的1例，術(shù)后1周內(nèi)降至1∶2; 術(shù)前1∶16的1例，術(shù)后第2～10周升高后自行降至1∶8。預(yù)防應(yīng)用抗生素和免疫抑制方案與血型相符肝移植基本相同，停用激素時間延遲3個月。結(jié)論在供肝緊缺情況下，通過完善圍手術(shù)期處理，包括IL2受體單抗、人丙種球蛋白的使用及合理的術(shù)后免疫抑制劑方案，結(jié)合脾切除術(shù)等措施，進行ABO血型不合的肝移植是可行的。

引用本文： 趙永恒,李立,冉江華,李來邦,李鑄,劉靜,蔣益舟,吳淑媛,梁宇,劉滇生. ABO血型不合肝移植4例臨床分析. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(6): 595-598. doi: 復(fù)制

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1. Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J]. Transplantation, 2003, 75(3): 347353.
2. SanchezUrdazpal L, Batts KP, Gores GJ, et al. Increased bile duct complications in liver transplantation across the ABO barrier [J]. Ann Surg, 1993, 218(2): 152158.
3. Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [J]. Lancet, 1990, 336(8714): 519523.
4. Hanto DW, Fecteau AH, Alonso MH, et al. ABOincompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation [J]. Liver Transpl, 2003, 9(1): 2230.
5. Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J].Transplantation, 2003, 75(3): 347353.
6. Stewart ZA, Locke JE, Montgomery RA, et al. ABOincompatible deceased donor liver transplantation in the United States: a national registry analysis [J]. Liver Transpl, 2009, 15(8): 883893.
7. Toso C, AlQahtani M, Alsaif FA, et al. ABOincompatible liver transplantation for critically ill adult patients [J]. Transpl Int, 2007, 20(8): 675681.
8. Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier [J]. Transplantation, 1994, 58(5): 543547.
9. Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABOincompatible livingdonor liver transplantation [J]. Transplantation, 2004, 77(3): 403411.
10. VarelaFascinetto G, Treacy SJ, Lillehei CW, et al. Longterm results in pediatric ABOincompatible liver transplantation [J]. Transplant Proc, 1999, 31(12): 467468.
11. Wu J, Ye S, Xu X, et al. Recipient outcomes after ABOincompatible liver transplantation: a systematic review and metaanalysis [J]. PLoS One, 2011, 6(1): e16521.
12. Shimmura H, Tanabe K, Ishikawa N, et al. Role of antiA/B antibody titers in results of ABOincompatible kidney transplantation [J]. Transplantation, 2000, 70(9): 13311335.
13. Ishikawa N, Yagisawa T, Sakuma Y, et al. Transplantation of ABOincompatible and living unrelated donorrecipient combinations [J]. Transplant Proc, 2008, 40(7): 22922293.
14. Ashizawa T, Matsuno N, Yokoyama T, et al. The role of plasmapheresis therapy for perioperative management in ABOincompatible adult living donor liver transplantation [J]. Transplant Proc, 2006, 38(10): 36293632.
15. Saliba F, Icha P, Azoulay D, et al. Successful longterm outcome of ABOincompatible liver transplantation using antigenspecific immunoadsorption columns [J]. Ther Apher Dial, 2010, 14(1): 116123.
16. Kim BW, Park YK, Kim YB, et al. Effects and problems of adult ABOincompatible living donor liver transplantation using protocol of plasma exchange, intraarterial infusion therapy, and antiCD20 monoclonal antibody without splenectomy: case reports of initial experiences and results in Korea [J]. Transplant Proc, 2008, 40(10): 37723777.
17. Ishida H, Koyama I, Sawada T, et al. AntiAB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation [J]. Transplantation, 2000, 70(4): 681685.
18. Shimazu M, Kitajima M. Living donor liver transplantation with special reference to ABOincompatible grafts and smallforsize grafts [J]. World J Surg, 2004, 28(1): 27.
19. 公偉, 列軍, 楊鳳輝, 等. ABO血型不合的肝移植(附3例報道 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 187190.
20. 梁廷波, 湯曉鋒, 王偉林, 等. 肝移植中應(yīng)用血型不合供肝的初步經(jīng)驗 [J]. 中華普通外科雜志, 2006, 21(6): 399402.
21. Tanabe M, Shimazu M, Wakabayashi G, et al. Intraportal infusion therapy as a novel approach to adult ABOincompatible liver transplantation [J]. Transplantation, 2002, 73(12): 19591961.
22. Nakamura Y, Matsuno N, Iwamoto H, et al. Successful case of adult ABOincompatible liver transplantation: beneficial effects of intrahepatic artery infusion therapy: a case report [J]. Transplant Proc, 2004, 36(8): 22692273.
23. 劉其雨, 李立, 李曉延. ABO血型不合肝移植的研究進展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 195198.
  1. 1. Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J]. Transplantation, 2003, 75(3): 347353.
  2. 2. SanchezUrdazpal L, Batts KP, Gores GJ, et al. Increased bile duct complications in liver transplantation across the ABO barrier [J]. Ann Surg, 1993, 218(2): 152158.
  3. 3. Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [J]. Lancet, 1990, 336(8714): 519523.
  4. 4. Hanto DW, Fecteau AH, Alonso MH, et al. ABOincompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation [J]. Liver Transpl, 2003, 9(1): 2230.
  5. 5. Bjro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donorrecipient ABO matching on the outcome after transplantation [J].Transplantation, 2003, 75(3): 347353.
  6. 6. Stewart ZA, Locke JE, Montgomery RA, et al. ABOincompatible deceased donor liver transplantation in the United States: a national registry analysis [J]. Liver Transpl, 2009, 15(8): 883893.
  7. 7. Toso C, AlQahtani M, Alsaif FA, et al. ABOincompatible liver transplantation for critically ill adult patients [J]. Transpl Int, 2007, 20(8): 675681.
  8. 8. Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier [J]. Transplantation, 1994, 58(5): 543547.
  9. 9. Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABOincompatible livingdonor liver transplantation [J]. Transplantation, 2004, 77(3): 403411.
  10. 10. VarelaFascinetto G, Treacy SJ, Lillehei CW, et al. Longterm results in pediatric ABOincompatible liver transplantation [J]. Transplant Proc, 1999, 31(12): 467468.
  11. 11. Wu J, Ye S, Xu X, et al. Recipient outcomes after ABOincompatible liver transplantation: a systematic review and metaanalysis [J]. PLoS One, 2011, 6(1): e16521.
  12. 12. Shimmura H, Tanabe K, Ishikawa N, et al. Role of antiA/B antibody titers in results of ABOincompatible kidney transplantation [J]. Transplantation, 2000, 70(9): 13311335.
  13. 13. Ishikawa N, Yagisawa T, Sakuma Y, et al. Transplantation of ABOincompatible and living unrelated donorrecipient combinations [J]. Transplant Proc, 2008, 40(7): 22922293.
  14. 14. Ashizawa T, Matsuno N, Yokoyama T, et al. The role of plasmapheresis therapy for perioperative management in ABOincompatible adult living donor liver transplantation [J]. Transplant Proc, 2006, 38(10): 36293632.
  15. 15. Saliba F, Icha P, Azoulay D, et al. Successful longterm outcome of ABOincompatible liver transplantation using antigenspecific immunoadsorption columns [J]. Ther Apher Dial, 2010, 14(1): 116123.
  16. 16. Kim BW, Park YK, Kim YB, et al. Effects and problems of adult ABOincompatible living donor liver transplantation using protocol of plasma exchange, intraarterial infusion therapy, and antiCD20 monoclonal antibody without splenectomy: case reports of initial experiences and results in Korea [J]. Transplant Proc, 2008, 40(10): 37723777.
  17. 17. Ishida H, Koyama I, Sawada T, et al. AntiAB titer changes in patients with ABO incompatibility after living related kidney transplantations: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation [J]. Transplantation, 2000, 70(4): 681685.
  18. 18. Shimazu M, Kitajima M. Living donor liver transplantation with special reference to ABOincompatible grafts and smallforsize grafts [J]. World J Surg, 2004, 28(1): 27.
  19. 19. 公偉, 列軍, 楊鳳輝, 等. ABO血型不合的肝移植(附3例報道 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 187190.
  20. 20. 梁廷波, 湯曉鋒, 王偉林, 等. 肝移植中應(yīng)用血型不合供肝的初步經(jīng)驗 [J]. 中華普通外科雜志, 2006, 21(6): 399402.
  21. 21. Tanabe M, Shimazu M, Wakabayashi G, et al. Intraportal infusion therapy as a novel approach to adult ABOincompatible liver transplantation [J]. Transplantation, 2002, 73(12): 19591961.
  22. 22. Nakamura Y, Matsuno N, Iwamoto H, et al. Successful case of adult ABOincompatible liver transplantation: beneficial effects of intrahepatic artery infusion therapy: a case report [J]. Transplant Proc, 2004, 36(8): 22692273.
  23. 23. 劉其雨, 李立, 李曉延. ABO血型不合肝移植的研究進展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 195198.