ABO血型不合肝移植20例单中心经验

Single center＇s experience of ABO-incompatible liver transplantation in 20 cases

目的总结我院开展的共20例ABO血型不符的肝移植病例，并探讨同类患者可能的治疗方案。方法2009年1月至2011年7月，我院共实施ABO血型不符肝移植20例，其中ABO血型不相容（ABO—incompatible，ABO—I）16例，ABO血型相容（ABO—compatible，ABO-C）4例，中位随访时间为（13．34-9．2）m。结果除术前MELD评分外，ABO．C及ABO．I组围手术期其他资料、术后并发症发生率及累积生存率比较差异无统计学意义。20例患者中死亡5例（ABO—C组2例，ABO—I组3例），1年生存率75％。死亡原因为围手术期多器官衰竭2例，肝癌复发2例，脑出血1例。ABO—I组术后发生排斥反应2例，术后远期出现胆道并发症3例，术后发生门静脉血栓3例。20例患者中，术后早期发生血肌酐升高共11例，发生率55％，其中6例术前即有血肌酐升高，此6例患者术后血肌酐升高时间均超过7d，其余7例患者血肌酐水平均在术后7d内降至正常。结论门静脉血流复通前行脾脏切除术，应用巴利昔单抗＋他克莫司＋霉酚酸酯＋皮质激素的四联免疫抑制方案，术后静脉应用前列地尔的治疗方案，对于有选择性的ABO血型不合肝移植患者可取得较好疗效。

Objective To summarize 20 ABO-incompatible liver transplantation cases in our hospital and explore the treatment strategy. Methods From January 2009 to July 2011,20 cases donor- recipient ABO blood type not-identical liver transplantation was performed at our hospital. 16 cases were ABO-incompatible（ABO-I） and 4 were ABO-compatible （ABO-C）. The median follow-up was （13.3 ＋ 9. 2） months. Results Except preoperative MELD score, there were no significant difference in other perioperative data, the incidence of postoperative complications and the cumulative survival rate between ABO-C and ABO-I group. There＇were 5 deaths in 20 cases, 2 cases in ABO-C group and 3 eases in ABO-I group, survival rate was 75%. The cause of death was perioperative multiple organ failure in 2 cases, liver cancer recurrence in 2 cases and cerebral hemorrhage in 1 case. There were 2 cases of acute rejection, 3 cases of biliary complications and 3 cases of portal vein thrombosis developing postoperatively. Eleven patients had increased serum creatinine after operation, preoperative high creatinine existgd in 6 cases and it maintained posttransplant high level for more than 7 days, the serum creatinine level in other 7 patients was back to normal level in 7 days. Conclusions A combination splenectomy before the portal vein reperfusion, the protocol of basiliximab, tacrolimus （ TAC ）/mycophenolate mofetil （ MMF ）/steroids immunosuppression treatment, postoperative peripheral vascular dilatation treatment by Alprostadil, help achieve favorable outcome in selected patients who underwent ABO-incompatible liver transplant.