ABO血型不合肝移植的现状和最新进展

Recent advances in ABO incompatible liver transplantation

肝移植已经成为当前治愈终末期肝病的最佳手段.由于全球性的器官短缺,多数重症肝衰竭患者因难以及时获得血型相合的供肝,而失去手术机会甚至死亡,过去被认为是移植障碍的ABO血型不合(ABO-incompatible,ABO-I)肝移植也就成为挽救其濒危生命的最佳选择.然而,与血型相合肝移植相比,ABO-I肝移植术后更容易发生严重抗体介导的排斥反应(antibody-mediated rejection,AMR)、胆道并发症、感染、血栓性微血管病以及急性肾损伤等并发症,使得其临床应用受到很大限制.近些年来,虽然随着血浆置换、免疫吸附、利妥昔单抗、脾切除、静脉注射免疫球蛋白和移植物局部灌注等新的防治措施的引入,使得ABO-I肝移植的效获得明显改善,但是目前仍面临着如何防治AMR以及并发症等关键问题的挑战.

Liver transplantation has become the best way to cure patients with end-stage liver disease. Due to the shortage of donor organs worldwide and being unable to obtain matched donor liver, most patients with severe hepatic failure lose the chance of operation or even die. As a result, ABO incompatible（ABO-I） liver transplantation has become a choice to save the endangered life. However, compared with ABO compatible liver transplantation, ABO-I liver transplantation is more prone to cause severe antibody mediated rejection（ AMR）, biliary complications, infection, thrombotic microangiopathy, and acute kidney injury. Consequently, its clinical application is limited. In recent years, with the progress of AMR prevention strategies such as immunoabsorption, plasmapheresis, rituximab, splenectomy, intravenous immunoglobulin, and graft perfusion, the clinical efficacy of ABO-I liver transplantation has been significantly improved, although it still faces the challenge of how to prevent and control AMR and postoperative complications.