人肝移植的抗体介导性排异与ABO配型不同之间的关系

The relationships between antibody-mediated rejection of human liver allografts and transplantation across ABO blood group barrier

目的探讨人肝移植的抗体介导性排异与ＡＢＯ配型不同之间的关系。方法实验组为３１例ＡＢＯ配型不同（ＡＢＯ－Ｉ）肝移植病例，并设立了ＡＢＯ配型相同（ＡＢＯ－Ｃ）的临床对照组和病理对照组，观察移植肝脏的存活时间、病理学特征和发病原因。结果ＡＢＯ－Ｃ临床对照组移植肝存活时间比ＡＢＯ－Ｉ组明显延长（Ｐ＜０．０１），而且病理所见和发病原因与ＡＢＯ－Ｉ组有明显不同。ＡＢＯ－Ｃ病理对照组与ＡＢＯ－Ｉ组的病理改变和免疫荧光检查均有所不同。结论移植肝脏存在抗体介导性排异的潜在因素和某些临床及病理改变，只是尚未达到普遍认同的诊断标准。

Objectives To sutdy the reltionship between antibody-mediated rejection of human liver allografts and transplantation across ABO blood group barrier. Methods dirty-one patients who had recieved ABO incompatible (ABO-I) liver the were studied and compared with the control group having been transplantedwith ABO compatible (ABO-C) grafts on both clinical and pathological gruound.Results The surival of ABO-C grafts was much longer than that of the ABO-I grafts(P<0.01) and there were significant differences inpathological changes and the cause of grafts failure between these two groups. The main difference in pathologicalchanges between ABO-C and ABO-I patients wes that no necrotizing and/or inflammatory vasculitis was foundin the former group. By ~immunofluorescence study, almost all cases in ABO-C group were negative for IgM,C1q, IgG and C3 in the arterial walls of the grafts having hepatic failure, but positive in those of the ABO-Igroup. Conclusion The potential factors and clinical and pathological changes of antibody-mediated rejectionmay be present in liver allografts, but do not reach the diagnostic standards yet.