ABO血型不合的肝移植(附3例报道)  

ABO-Incompatible Liver Transplantation(Report of 3 Cases)

作　　者：公伟[1] 刘军[1] 杨凤辉[1] 许世峰[1] 周旭[1] 于光圣[1] 徐延田[1] 卢俊[1] 

机构地区：[1]山东大学附属省立医院器官移植,肝胆外二科,济南250021

出　　处：《中国普外基础与临床杂志》2009年第3期187-190,共4页Chinese Journal of Bases and Clinics In General Surgery

基　　金：山东省科技攻关计划项目资助(项目编号:2007GG3W202042)~~

摘　　要：目的探讨ABO血型不合的肝移植治疗急性肝功能衰竭的疗效。方法回顾性分析我院急诊状态下开展的3例(布加综合征患者1例,肝癌患者1例,重症乙型肝炎患者1例)ABO血型不合的肝移植患者的临床资料,术后以四联免疫抑制剂抗排斥反应。结果1例布加综合征患者术后相继出现肺部感染、脑桥髓鞘溶解症及急性排斥反应,经积极对症处理后缓解,现已存活14个月;1例肝癌患者术后出现不可控制的感染,术后13 d因多脏器功能衰竭死亡;1例重症乙型肝炎患者术后出现急性肾功能衰竭,给予持续肾脏替代疗法,肾功能恢复。结论ABO血型不合的肝移植术后并发症多,通过加强围手术期管理和应用有效的免疫抑制方案,可提高ABO血型不合肝移植的疗效。在无合适供体的紧急情况下,ABO血型不合的肝移植可以作为急性肝功能衰竭患者的一个重要选择。Objective To investigate the effect of ABO-incompatible liver transplantation on patients with acute hepatic failure. Methods A retrospective review was undertaken on the clinical data of 3 cases （1 case of Budd-Chiari syndrome, 1 case of liver cancer and 1 case of severe hepatitis B were included） undergoing ABO-incompatible liver transplantation for acute hepatic failure. The patients were given quadruple immunosuppression after operation. Results Postoperative complications including pulmonary infection, central pontine myelionlysis and acute rejection was suffered from by the patient of Budd-Chiari syndrome who was then given a positive deal and had survived for more than 14 months. The patient of liver cancer was aggravated by severe infection who died of multiple organ failure on day 13 after operation. The patient with severe hepatitis B was made more severe by acute renal failure whose kidney function was restored with continuous renal replacement therapy. Conclusion The outcome of ABO-incompatible liver transplantation can be improved with refined peri-transplant management and better immunosuppressive strategies. ABO-incompatible liver transplantation should be viewed as an important option in patients with acute hepatic failure awaiting an emergency procedure.

关 键 词：肝移植 血型不合 急性肝功能衰竭 

分 类 号：R657.3[医药卫生—外科学]