肝移植中应用ABO血型不合供肝的初步经验  

The preliminary clinical experience on ABO-incompatiblc liver transplantation

作　　者：梁廷波[1] 汤晓锋[1] 王伟林[1] 卢安卫[1] 沈岩[1] 张珉[1] 俞军[1] 庄莉[1] 张赛君[1] 郑树森[1] 

机构地区：[1]浙江大学医学院附属第一医院肝胆胰外科,杭州310003

出　　处：《中华普通外科杂志》2006年第6期399-402,共4页Chinese Journal of General Surgery

基　　金：国家"九七三"重点基础研究发展规划基金(2003CB5155001);卫生部省部共建基金(WKJ2005-2-044-01

摘　　要：目的探讨急诊状况下ABO血型不合肝移植的疗效及其预后影响因素。方法410例原位肝移植中有8例为ABO血型不合的急诊肝移植,其中受体血型O型5例、非O型3例。术后以四联免疫抑制剂抗排斥反应,观察受体急性排斥反应、血管、胆道并发症、感染和肝肾功能情况。结果患者半年存活率为50%,围手术期死亡率为50%。受体血型O型和非O型、MELD (model for end-stage liver disease)评分＜30分和≥30分、CTP(Child-Turcotte-Pugh)评分＜13分和≥13分、重型肝炎和非重型肝炎、脾切除和非脾切除患者的半年存活率分别为80%和0%、50%和33%、75%和25%、25%和75%、33%和60%。术后并发症有：急性排斥反应1例；胆漏1例；肝叶坏死和肝脓肿2例；肾功能衰竭2例；感染6例(2例为曲霉菌感染)。结论ABO血型不合肝移植预后不佳,围手术期死亡率高,因此仅适用于无法及时获得合适供肝的急诊肝移植。Objective To evaluate emergent ABO-incompatible liver transplantation. Methods From April 1993 to April 2005, 8 patients including 5 with O type and 3with non-O type received emergent orthotopic liver transplantation（EOLT） with ABO-incompatible grafts among 410 OLT cases, All 8 patients were treated with quadruple immunosuppression therapy including Tacrolimus （FKS06）, mycophenolate mofetil （MMF）, methylprednisolone and IL-2R antibody （Daclizumab or Basilixmab ） perioperatively, Acute rejection, vascular thromboses, biliary tract complication, infection status, and liver and kidney function were monitored. Results The 6-month patient survival rate was 50%, The mortality in perioperative period was 50% due to haemorrhage, infection, and multiorgan failure. The patient survival rates at 6 months with O blood group and non-O blood group, MELD （ Model for End-Stage Liver Disease） score 〈30 and ≥30, CTP （Child-Turcotte-Pugh） score 〈 13 and ≥13, severe hepatitis B and non-severe hepatitis B, splenectomy and non-splenectomy were 80% and 0%, 50% and 33%, 75% and 25%, 25% and 75%, 33% and 60%, respectively. Postoperative complications included acute rejection occurred in one recipient successfully treated by methylprednisolone, bile leakage in 1, liver necrosis and abscess in 2, renal failure in 2, and bacteria or/and fungus infection in 6. Conclusions The prognosis of patients receiving ABO incompatible liver graft is poor, hence it is only applicable in the setting of emergency.

关 键 词：肝移植 血型不合 ABO血型系统 

分 类 号：R657.3[医药卫生—外科学]