肝移植后过客淋巴细胞综合征回顾性分析

Retrospective analysis of passer-by lymphocyte syndrome after liver transplantation

目的对肝移植术后过客淋巴细胞综合征(PLS)进行分析研究,减少以往多中心混杂因素造成的结果偏倚,弥补PLS缺少统计性分析的空白,给肝移植术后PLS诊断治疗提供参考。方法对天津市第一中心医院2018年至2019年供、受者ABO血型次要不合或双向不合的肝移植受者进行回顾性分析。PLS诊断标准:排除术后感染、急性排斥反应、外科失血因素后血红蛋白(HGB)持续下降,实验室检查具备溶血指征,红细胞直抗阳性,放散液检出针对受者自身抗原的抗体。共进行肝移植666例,其中供、受者ABO血型次要不合或双向不合的52例,10例(19.23%)发生PLS,42例未发生PLS(80.77%)。采用卡方检验、Fisher精确检验分析肝移植后PLS发生组与未发生组之间的变量。结果受者性别、年龄、血型、供、受者血型错配方式、免疫抑制剂类型、术后转归均与PLS发生无相关性。受者术后输血与PLS发生存在相关性(P<0.05);供者血型B型发生PLS风险高于A型、O型(P<0.05)。结论PLS是造成肝移植术后贫血的因素之一,B型供者淋巴细胞产生抗A抗体是PLS的高风险因素。

Objective To explore the prevalence of passenger lymphocyte syndrome(PLS)after liver transplantation,minimize the result bias caused by previous multicenter confounding factors,make up for the lack of statistical analysis of PLS and provide reference for a diagnosis and treatment of PLS after liver transplantation.Methods We reviewed liver transplants performed in our center from 2018 to 2019,searching for cases with minor ABO incompatibility or bidirectional ABO incompatibility.Diagnostic criteria for PLS:laboratory confirmation included biochemical identifiers of hemolysis,positivity of the direct antiglobul in test(DAT),donor attributed anti-recipient antibody in recipient's sera,and exclusion of other causes of decreased HGB(i.e.postoperative infection,acute rejection&surgical blood loss).A total of 666 liver transplants were performed.Among 52 patients with minor ABO incompatibility or bidirectional ABO incompatibility,10 cases developed PLS(19.23%)and 42 cases did not(80.77%).Statistical comparisons between patients with and without PLS were performed using the chi-square test and Fisher's exact test.Results There were no statistically significant differences in PLS group subjects in terms of sex,age,blood group,type of incompatibility,type of immunosuppressants and postoperative outcome.There was statistically significant correlation between postoperative blood transfusion and PLS(P<0.05),and donor blood group B cohort demonstrated a higher risk of PLS than donor blood group A and O cohorts(P<0.05).Conclusions PLS is one of the causes for postoperative anemia in liver transplantation,and donor blood group B graft is a risk factor for PLS.