ABO血型不同供肝肝移植的临床应用

Clinical experience of ABO-diffferent liver transplantation

目的:探讨供受体ABO血型不同肝移植的治疗及效果。方法:回顾性分析15例ABO血型不同肝移植临床资料。血型相容的6例采用常规治疗。血型不相容的9例均于术中显微镜下吻合肝动脉和胆道,术后采用四联免疫治疗方案及抗凝治疗,其中1例术前行血浆置换,5例术中切除脾脏。结果:血型相容的6例无并发症出现。血型不相容的9例中,4例患者顺利恢复,无并发症;其余5例中,3例出现急性排异反应,4例出现胆道非吻合口狭窄,3例死亡。结论:ABO血型不同但相容的供肝肝移植效果良好,血型不相容的供肝肝移植并发症多。当供体缺乏而受者病情不能等待时,可以选择性进行,但应该尽量减少并发症发生。

Objective： To explore the treatment and effect of ABO-different orthotopic liver transplantation（OLT）. Methods： Fifteen cases of ABO-different OLT were analyzed retrospectively. Six cases of ABO-different but compatible OLT were treated routinely. In 9 cases of ABO-incompatible OLT, plasma exchange was done in 1 case before operation, splenectomy was done in 5 cases during operation, the hepatic artery and biliary duct anastomosis were performed by the microvascular technique. The immuno suppressive protocol included a quadruple drug therapy, and anticoagulant therapy were performed postoperation. Results： No complications were found in 6 cases of ABO-different but compatible OLT. Of the 9 cases of ABO-incompatible OLT, 4 patients recovered smoothly without complications. Postoperative complications included acute rejection in 3 patients, biliary nonanastomotic stricture in 4 patients, and 3 cases died. Conclusion： The effect of ABO-different but compatible OLT is good. ABO-incompatible OLT can be used when the graft is scarce, but we should manage to decrease the complications.