小儿ABO血型不合肝移植16例的临床分析

Clinical analysis of ABO-incompatible pediatric liver transplantation in 16 patients

目的探讨小儿ABO血型不合肝移植预后及安全性。方法回顾分析2006年9月20日至2014年12月31日进行的196例小儿活体肝移植病例，其中16例为ABO血型不合肝移植。16例小儿中位年龄为6个月（5个月～1岁2个月）；供、受者血型情况：3例为AB型供A型，1例为AB型供B型，4例为A型供0型，7例为B型供0型，1例为B型供A型。所有受者均于术中及术后分别给予巴利昔单抗10mg，术后均给予他克莫司联合甲泼尼龙的免疫抑制方案。4例受者入院时血型抗体滴度IgM高于1：16，术前及术后分别给予静脉输注人免疫球蛋白300mg·kg-1·d-1，连用7d，其中1例受者肝移植术前行血浆置换治疗（100ml血浆／艇）后抗体滴度均降至1：16。术后随访9～26个月，观察受者及移植物存活率，急性排斥反应发生率，以及术后并发症发生率。结果随访期间，16例受者及移植物均存活。1例术后发生急性排斥反应，给予甲泼尼龙10mg·kg-1·d-1冲击治疗3d后痊愈；术后发生门静脉狭窄2例，肝内胆管扩张1例，EB病毒血症8例，巨细胞病毒（CMV）血症5例，肺部感染6例。术后3周内，所有受者的转氨酶、碱性磷酸酶、谷氨酰转肽酶及胆红素水平均逐渐恢复正常。结论小儿AB0血型不合肝移植安全性较高，预后良好。

Objective To evaluate the safety and clinical effect of ABO-incompatible （ILT） pediatric living donor liver transplantation. Method We analyzed 169 pediatric living donor liver transplantation recipients from Sept. 20, 2006 to Dec. 31, 2014. There were 16 ABO-incompatible liver transplantation cases. The median age was 6 months. The blood agglutitin titer was monitored. The titer was controlled lower or equal to 1 ： 16. The method to decrease blood agglutitin titer included IVIG and plasma exchange. The patients were treated with Tacrolimus combined with methylprednisolone. Basiliximab for injection was used. The patients were followed-up for 9 - 26 months. The survival rate, acute rejection, vascular and biliary tract complications, and infection were monitored. Result All the patients survived. There was once case of acute rejection, 1 case of bile duct dilatation, 2 cases of portal vein stenosis, 8 cases of EBV viremia, 5 cases of CMV viremia, and 6 cases of lung infection. The liver functions of all the 16 recipients were recovered within 3 weeks. Conclusion ~incompatible liver grafts can be used safely in pediatric patients.