供受者ABO血型不符的成人肝脏移植疗效评价

Clinical efficacies of ABO-incompatible adult liver transplantation

目的探讨ABO血型不符的供肝在成人肝移植中应用的安全性及对患者术后并发症及预后的影响。方法回顾性分析本中心97例因重症乙型病毒性肝炎行肝移植的成人患者临床资料，根据供受者ABO血型相符情况分为3组：ABO血型相同（ABO—Id）组58例，ABO血型相容（ABO—C）组19例，ABO血型不合（ABO—In）组20例。术后观察比较各组患者的急性排斥反应、感染、血管和胆道并发症及移植肝和患者存活率之间的差异。结果3组患者术后3个月、1年和3年的移植肝存活率分别是87．9％、84．2％、50．0％，77．6％、73．7％、35％和65．3％、66．5％、33．3％；患者牛存率分别是87．9％、84．2％、60．0％，81．0％、78．9％、40％和69．1％、68．7％、33．3％；ABO—In组均显著低于ABO—Id组和ABO—C组（P〈0．05）。3组患者术后急性排斥反应的发生率分别是8．6％、10．5％和35．0％；感染发生率分别是20．7％、26．3％和60．0％；血管并发症发生率分别是3．4％、5．3％和20％；胆道并发症发生率分别是6．9％、10．5％和30．0％；ABO—Id组和ABO—C组之间不存在显著性差异（P〉0．05），ABO—In组显著高于ABO-Id组和ABO-C组（P〈0．05）。结论ABO血型相容的肝脏移植不影响患者的疗效及预后，可以作为供肝短缺形势下重症乙肝患者的常规选择；但ABO血型不合的肝脏移植术后并发症发生率高，移植物和患者存活率较低，仅能作为紧急情况下挽救患者生命的手段，往往需要行再次肝移植。

Objective To evaluate the efficacy and safety of ABO-incompatible liver transplantation in adult patients with fulminant hepatitis B. Methods The clinical data of 97 cases of adult liver transplantation for fulminant hepatitis B were retrospectively analyzed. The patients were grouped as ABOidentical （ABO-Id, n = 58） , ABO-compatible （ABO-C, n = 19） and ABO-incompatible （ ABO-In, n = 20）. The rates of rejection, infection, biliary tract complications, vascular complications, and patient and graft survivals were compared among 3 groups. Results The 3-month, 1-year and 3-year graft survival rates were 87.9%/77.6%/65.3% in ABO-Id group, 84. 2%/73.7%/66. 5% in ABO-C group and 50. 0%/ 35.0%/33.3% in ABO-In group respectively. There were significant differences between ABO-Id and ABO- In （ P 〈 0. 05 ）. The incidences of rejection, infection, vascular complications and biliary tract complications were 8.6%, 20. 7%, 3.4% and 6. 9% inABO-Id group, 35%, 60%, 20% and 30% in ABO-In group （P 〈 0.05） and 10. 5%, 26. 3%, 5.3% and 10. 5% respectively in ABO-C group （P 〉 0.05）. Conclusion ABO-C liver transplantation is an important therapeutic option in adult patients with acute liver failure awaiting an emergency procedure. ABO-In transplantation can be used only for life-rescuing in patients with fulminant hepatitis since it is associated with a higher risk of rejection, infection, vascular thrombosis, ischemic bile duct complications and poor patient and graft survival.