ABO血型不合的肝移植(附3例報道)_《中國普外基礎與臨床雜志》

作者：

公偉 , 劉軍 , 楊鳳輝 , 許世峰 , 周旭 , 于光圣 , 徐延田 , 盧俊

山東大學附屬省立醫院器官移植、肝膽外二科（濟南250021）;

關鍵詞：

肝移植血型不合急性肝功能衰竭

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目的　探討ABO血型不合的肝移植治療急性肝功能衰竭的療效。
方法　回顧性分析我院急診狀態下開展的3例(布加綜合征患者1例，肝癌患者1例，重癥乙型肝炎患者1例)ABO血型不合的肝移植患者的臨床資料，術后以四聯免疫抑制劑抗排斥反應。
結果　1例布加綜合征患者術后相繼出現肺部感染、腦橋髓鞘溶解癥及急性排斥反應，經積極對癥處理后緩解，現已存活14個月； 1例肝癌患者術后出現不可控制的感染，術后13 d因多臟器功能衰竭死亡； 1例重癥乙型肝炎患者術后出現急性腎功能衰竭，給予持續腎臟替代療法，腎功能恢復。
結論　ABO血型不合的肝移植術后并發癥多，通過加強圍手術期管理和應用有效的免疫抑制方案，可提高ABO血型不合肝移植的療效。在無合適供體的緊急情況下，ABO血型不合的肝移植可以作為急性肝功能衰竭患者的一個重要選擇。

引用本文： 公偉,劉軍,楊鳳輝,許世峰,周旭,于光圣,徐延田,盧俊. ABO血型不合的肝移植(附3例報道). 中國普外基礎與臨床雜志, 2009, 16(3): 187-190. doi: 復制

1.	Gordon RD, Fung JJ, Iwatsuki S, et al. Immunological factors influencing liver graft survival [Ｊ]. Gastroenterol Clin North Am, 1988; 17(1):53.
2.	Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [Ｊ]. Lancet, 1990; 336(8714):519.
3.	Reding R, Veyckemans F, de Ville de Goyet J, et al. ABO-incompatible orthotopic liver allografting in urgent indications [Ｊ]. Surg Gynecol Obstet, 1992; 174(1):59.
4.	Farges O, Kalil AN, Samuel D, et al. The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients [Ｊ]. Transplantation, 1995; 59(8):1124.
5.	Wu A, Bühler LH, Cooper DK. ABO-incompatible organ and bone marrow transplantation: current status　[Ｊ]. Transpl Int, 2003; 16(5):291.
6.	Rydberg L. ABO-incompatibility in solid organ transplantation [Ｊ]. Transfus Med, 2001; 11(4):325.
7.	Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation [Ｊ]. Transplantation, 2004; 77(3):403.
8.	Takahashi K, Saito K, Takahara S, et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan [Ｊ]. Am J Transplant, 2004; 4(7):1089.
9.	Sugawara Y, Makuuchi M. Adult liver transplantation using live ABO-incompatible grafts in Western countries [Ｊ]. Liver Transpl, 2006; 12(9):1324.
10.	Boberg KM, Foss A, Midtvedt K, et al. ABO-incompatible deceased donor liver transplantation with the use of antigen-specific immunoadsorption and anti-CD20 monoclonal antibody [Ｊ]. Clin Transplant, 2006; 20(2):265.
11.	Koukoutsis I, Bellagamba R, Tamijmarane A, et al. Outcomes after identical and compatible orthotopic liver transplantation for fulminant hepatic failure: a single center experience in UK [Ｊ]. Transpl Int, 2007; 20(8):659.
12.	Mahendran AO, Veitch PS. Paired exchange programmes can expand the live kidney donor pool [Ｊ]. Br J Surg, 2007; 94(6):657.
13.	Toso C, Al-Qahtani M, Alsaif FA, et al. ABO-incompatible liver transplantation for critically ill adult patients [Ｊ]. Transpl Int, 2007; 20(8):675.
14.	Skogsberg U, Breimer ME, Friman S, et al. Adult ABO-incompatible liver transplantation, using A and B donors [Ｊ]. Xenotransplantation, 2006;　13(2):154.
15.	Whiting JF, Fecteau A, Martin J, et al. Use of low-dose OKT3 as induction therapy in liver transplantation [Ｊ]. Transplantation, 1998; 65(4):577.
16.	Hashimoto T, Kondo S, Suzuki T, et al. Strategy for ABO-incompatible living-related liver transplantation [Ｊ]. Transplant Proc, 2000; 32(7):2104.
17.	Hanto DW, Fecteau AH, Alonso MH, et al. ABO-incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation [Ｊ]. Liver Transpl, 2003; 9(1):22.
18.	Kawagishi N, Satoh K, Enomoto Y, et al. New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (rituximab) and plasma exchange [Ｊ]. Transplant Proc, 2005; 37(2):1205.
19.	李軍, 竇科峰, 朱靚, 等. 人肝移植術后移植肝臟熱休克蛋白70的表達及意義 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(6):426.
20.	朱新鋒, 陳剛, 張文奪, 等. 肝移植術后應用胸腺肽α1對急性排斥反應的影響 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(6):430.
21.	Kozaki K, Egawa H, Kasahara M, et al. Therapeutic strategy and the role of apheresis therapy for ABO incompatible living donor liver transplantation [Ｊ]. Ther Apher Dial, 2005; 9(4):285.
22.	Kozaki K, Egawa H, Ueda M, et al. The role of apheresis therapy for ABO incompatible living donor liver transplantation: the Kyoto University experience [Ｊ]. Ther Apher Dial, 2006; 10(5):441.
23.	葉啟發, 佘興國, 明英姿, 等. 脾切除對肝移植預后影響的回顧性探討 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(3):159.

1. Gordon RD, Fung JJ, Iwatsuki S, et al. Immunological factors influencing liver graft survival [Ｊ]. Gastroenterol Clin North Am, 1988; 17(1):53.
2. Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [Ｊ]. Lancet, 1990; 336(8714):519.
3. Reding R, Veyckemans F, de Ville de Goyet J, et al. ABO-incompatible orthotopic liver allografting in urgent indications [Ｊ]. Surg Gynecol Obstet, 1992; 174(1):59.
4. Farges O, Kalil AN, Samuel D, et al. The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients [Ｊ]. Transplantation, 1995; 59(8):1124.
5. Wu A, Bühler LH, Cooper DK. ABO-incompatible organ and bone marrow transplantation: current status　[Ｊ]. Transpl Int, 2003; 16(5):291.
6. Rydberg L. ABO-incompatibility in solid organ transplantation [Ｊ]. Transfus Med, 2001; 11(4):325.
7. Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation [Ｊ]. Transplantation, 2004; 77(3):403.
8. Takahashi K, Saito K, Takahara S, et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan [Ｊ]. Am J Transplant, 2004; 4(7):1089.
9. Sugawara Y, Makuuchi M. Adult liver transplantation using live ABO-incompatible grafts in Western countries [Ｊ]. Liver Transpl, 2006; 12(9):1324.
10. Boberg KM, Foss A, Midtvedt K, et al. ABO-incompatible deceased donor liver transplantation with the use of antigen-specific immunoadsorption and anti-CD20 monoclonal antibody [Ｊ]. Clin Transplant, 2006; 20(2):265.
11. Koukoutsis I, Bellagamba R, Tamijmarane A, et al. Outcomes after identical and compatible orthotopic liver transplantation for fulminant hepatic failure: a single center experience in UK [Ｊ]. Transpl Int, 2007; 20(8):659.
12. Mahendran AO, Veitch PS. Paired exchange programmes can expand the live kidney donor pool [Ｊ]. Br J Surg, 2007; 94(6):657.
13. Toso C, Al-Qahtani M, Alsaif FA, et al. ABO-incompatible liver transplantation for critically ill adult patients [Ｊ]. Transpl Int, 2007; 20(8):675.
14. Skogsberg U, Breimer ME, Friman S, et al. Adult ABO-incompatible liver transplantation, using A and B donors [Ｊ]. Xenotransplantation, 2006;　13(2):154.
15. Whiting JF, Fecteau A, Martin J, et al. Use of low-dose OKT3 as induction therapy in liver transplantation [Ｊ]. Transplantation, 1998; 65(4):577.
16. Hashimoto T, Kondo S, Suzuki T, et al. Strategy for ABO-incompatible living-related liver transplantation [Ｊ]. Transplant Proc, 2000; 32(7):2104.
17. Hanto DW, Fecteau AH, Alonso MH, et al. ABO-incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation [Ｊ]. Liver Transpl, 2003; 9(1):22.
18. Kawagishi N, Satoh K, Enomoto Y, et al. New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (rituximab) and plasma exchange [Ｊ]. Transplant Proc, 2005; 37(2):1205.
19. 李軍, 竇科峰, 朱靚, 等. 人肝移植術后移植肝臟熱休克蛋白70的表達及意義 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(6):426.
20. 朱新鋒, 陳剛, 張文奪, 等. 肝移植術后應用胸腺肽α1對急性排斥反應的影響 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(6):430.
21. Kozaki K, Egawa H, Kasahara M, et al. Therapeutic strategy and the role of apheresis therapy for ABO incompatible living donor liver transplantation [Ｊ]. Ther Apher Dial, 2005; 9(4):285.
22. Kozaki K, Egawa H, Ueda M, et al. The role of apheresis therapy for ABO incompatible living donor liver transplantation: the Kyoto University experience [Ｊ]. Ther Apher Dial, 2006; 10(5):441.
23. 葉啟發, 佘興國, 明英姿, 等. 脾切除對肝移植預后影響的回顧性探討 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(3):159.

《中國普外基礎與臨床雜志》

ABO血型不合的肝移植(附3例報道)

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《中國普外基礎與臨床雜志》

ABO血型不合的肝移植(附3例報道)

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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