儿童ABO血型不相容肝移植临床分析

Clinical analysis of pediatric ABO incompatible liver transplantation

目的探讨儿童血型不合肝移植的临床效果及预后。方法回顾性分析2014年1月1日至2022年12月31日天津市第一中心医院儿童器官移植科1607例儿童肝移植受者的临床资料,根据供受者ABO血型分为A组(供、受者ABO血型相同,1077例)、B组(供、受者ABO血型相合,288例)、C组(供、受者ABO血型不合,242例)。观察并比较三组受者术后并发症的发生情况、患者及移植物存活率。结果1607例受者术后1、3、5年总体生存率分别为95.7%、94.6%、94.0%,三组受者1、3、5年生存率无显著性差异(P=0.797)。三组1、3、5年移植物生存率无显著性差异(P=0.366)。在术后并发症中,三组之间在细胞性排斥反应(P<0.001)、胆道狭窄(P=0.016)、肝动脉血栓形成发生率(P=0.030)存在显著性差异。结论儿童血型不合肝移植是安全可行的,可有效的扩大供肝范围,使更多的患儿受益。

Objective To investigate the clinical outcomes and prognosis of ABO incompatible liver transplantation in children.Methods A retrospective analysis of clinical data from 1607 pediatric liver transplant recipients at the Pediatric Organ Transplantation Department of Tianjin First Central Hospital between January 1,2014,and December 31,2022 was performed.Recipients were categorized into three groups based on ABO blood type compatibility with donors:Group A(ABO-identical,1077 cases),Group B(ABO-compatible,288 cases),and Group C(ABO-incompatible,242 cases).Postoperative complications,patient survival rates,and graft survival rates were observed and compared among the three groups.Results The overall 1,3,and 5 year survival rates of the 1,607 recipients were 95.7%,94.6%,and 94.0%,respectively,with no significant differences(P=0.797).Similarly,there were no significant differences in graft survival rates at 1,3,and 5 years among the three groups(P=0.366).However,there were significant differences in the incidence of postoperative complications,including cellular rejection(P<0.001),biliary stricture(P=0.016),and hepatic artery thrombosis(P=0.030),among the three groups.Conclusion Pediatric ABO incompatible liver transplantation is safe and feasible,effectively expanding the donor pool and benefiting more pediatric patients.