ABO血型不相容肝移植策略

Strategies for ABO-incompatible liver transplantation

随着器官移植的高速发展,全球性器官短缺问题日益凸显。肝移植是目前治疗终末期肝病最有效的手段,但供者短缺一直是制约肝移植发展的关键问题,我国是乙型病毒性肝炎大国,供肝短缺问题尤为显著,很多危重症患者往往因为无法及时获得匹配的供肝,而失去最佳时机甚至死亡。ABO血型不相容(ABOi)肝移植作为一种扩大供者资源的策略,为那些等待合适供者的患者提供了新的希望。然而,由于ABOi肝移植术后更容易发生严重感染、抗体介导的排斥反应(AMR)、胆道并发症、血栓性微血管病以及急性肾损伤等并发症,因此备受争议。本文综述了ABOi肝移植的术前、术中和术后策略研究进展,旨在为ABOi肝移植临床应用及研究提供参考。

With rapid development of organ transplantation,the issue of global organ shortage has become increasingly prominent.At present,liver transplantation is the most effective treatment for end-stage liver disease.Nevertheless,the shortage of donors has been a key problem restricting the development of liver transplantation.China is a country with a larger number of hepatitis B,and the shortage of donor liver is particularly significant.Many critically ill patients often lose the best opportunity or even die because they cannot obtain a matched donor liver in time.As a strategy to expand the donor pool,ABO-incompatible(ABOi)liver transplantation offers new options for patients who are waiting for matched donors.However,ABOi liver transplantation is highly controversial due to higher risk of complications,such as severe infection,antibody-mediated rejection(AMR),biliary complications,thrombotic microangiopathy,and acute kidney injury,etc.In this article,research progress in preoperative,intraoperative and postoperative strategies of ABOi liver transplantation was reviewed,aiming to provide reference for clinical application and research of ABOi liver transplantation.