血型不合肝移植治疗肝功能衰竭  

ABO-incompatible liver transplantation for liver failure

作　　者：杨扬[1] 许赤[1] 陈颖华[1] 陆敏强[1] 蔡常洁[1] 李华[1] 汪根树[1] 易述红[1] 张剑[1] 易慧敏[1] 张俊峰[1] 姜楠[1] 赵辉[1] 李玺[1] 李敏如[1] 陈规划[1] 

机构地区：[1]中山大学器官移植研究所

出　　处：《中华医学杂志》2007年第40期2833-2836,共4页National Medical Journal of China

基　　金：国家"973"重点基础研究发展计划基金(2003CB515500);国家自然科学基金(30571769);广东省科技计划基金(2004B35001003);广东省自然科学基金团队(05200177);广东省医学科研基金(A2002164)

摘　　要：目的探讨血型不合肝移植治疗肝功能衰竭的可行性和疗效。方法回顾性分析本中心包括21例血型不合在内的66例肝移植治疗肝功能衰竭的临床资料,包括终末期肝病模型(MELD)评分、生存率和主要并发症的发生率。结果血型相同组和血型不合组受体 MELD 评分分别为31.7±3.2和32.8±2.9,差异无统计学意义(P=0.154)。两组平均生存时间分别为(806.0±70.0)d 和(720.3±118.5)d,术后3个月、1年、2年、3年生存率分别为84.2%、77.4%、67.6%、60.1%和75.6%、64.0%、58.2%、58.2%,两组累积生存率差异无统计学意义(P=0.417)。急性排斥反应发生率分别为8.9%(4/45)和19.0%(4/21),差异无统计学意义(P=0.253)。血型不合组术后感染和肌道并发症发生率分别为76.2%(16/21)和28.6%(6/21)显著高于相同组的48.9%(22/45,P=0.037)和8.9%(4/45,P=0.038)。严重感染和肾功能哀竭是血型不合肝移植术后早期主要死亡原因。结论在血型相同供肝严重短缺的情况下,ABO 血型不同肝移植是治疗肝功能衰竭的有效手段。感染和肾功能哀竭是围手术期最主要死因。合理的免疫抑制治疗、有效控制感染、加强围手术期的管理是提高血型不合肝移植成功率的关键。Objective To evaluate the efficacy of ABO-incompatible orthotopic liver transplantation （OLT） in treatment of liver failure. Methods The clinical data of 66 cases of OLT, including 21 cases of ABO-incompatible OLT, for liver failure were retrospectively analyzed. Results The 3-month, and 1-, 2-, and 3-year survival rates of the ABO-identical group were 84. 2% , 77. 4% , 67. 6% , and 60. 1%, respectively, while those of the ABO-incompatible group were 75.6%, 64.0%, 58.2%, and 58.2%, respectively. The mean survival time of the ABO-identical group was （806.0± 70.0） d, not significantly different from that of the ABO-incompatible group （720.3 ± 118.5 d, P = 0.417）. The acute rejection rate of the ABO-identical group was 8.9% , not significantly different from that of ABO-incompatible group （9. 0% , P =0.253）. The biliary tract complication rate and infection rate of the ABO-incompatible group were 76.2% and 28.6% respectively, both significantly higher than those of the ABO-identical group （48.9% and 8.9% respectively, P =0. 037 and P =0. 038）. The major causes of death in the ABO- incompatible group were serious infection （5/21） and renal failure （4/21）. Conclusion ABO- incompatible OLT is an acceptable option to cure liver failure in emergency. Intensive perioperative supervision is essential to improve the effect of ABO-incompatible OLT.

关 键 词：ABO血型 肝移植 肝功能衰竭 MELD 

分 类 号：R657.3[医药卫生—外科学]