血型不相容肝移植新型策略临床的应用  

Application of a new strategy in ABO-incompatible liver transplantation

作　　者：李志伟[1] 李超[1] 马继韬[1] 陈娟[1] 王胤佳[1] 周志刚[1] 梁爱君[1] 

机构地区：[1]云南省昆明市第一人民医院移植中心外科ICU,昆明云南650011

出　　处：《中国普通外科杂志》2011年第1期6-10,共5页China Journal of General Surgery

摘　　要：目的探讨血型不相容肝移植新型策略运用的疗效。方法回顾性分析血型不相容同种异体原位肝移植4例临床资料,4例均为成人ABO血型不相容肝移植,3例AB型供给O型,1例AB型RH(+)供给A型RH(-)。采用术前设定的围术期新策略预防急性排斥反应,包括四联免疫抑制剂、选择性血浆置换、术后输注免疫球蛋白和前列腺素E1、术中切脾、降阶梯策略预防及治疗术后感染。结果 1例患者术后第3天发生抗体介导的超急性排异反应,经血浆置换联合甲基强的松龙冲击治疗治愈;2例发生急性肾功衰,经床旁血液净化治愈;所有患者术后均发生感染并治愈,全部存活出院,随诊2～10个月,肝肾功正常。结论采用四联免疫抑制剂﹑术中切出脾脏﹑选择性血浆置换,输注免疫球蛋白及脂质体前列腺素E1及降阶梯抗感染治疗新策略,也许是提高跨血型肝移植成功率的有效办法之一。Objective To evaluate the effectiveness of a new strategy in ABO-incompatible liver transplantation.Methods We retrospectively analyzed the clinical records of 4 cases of ABO-incompatible allogeneic orthotopic liver transplantation performed in our hospital.Among them,3 blood type O recipients received livers from blood type AB donors,and one type A RH（-）recipient received liver from blood type AB RH（＋）donor.A new strategy of perioperative mangement was used for prevention of acute rejection,that included perioperative mangement with quadri-immunosuppressant,PPE,postoperational infusion of IVIG and prostaglandin E1,splenectomy and De-Escalation of antibiotics to prevent and treat postoperative infection.Results One patient had antibody-mediated rejection three days after operation and recovered after plasma exchange combined with high dose steroid treatments;2 patients had acute renal failure and recovered after continuous venovenous hemofiltration（CVVH） for 2 weeks.All patients had infection postoperatively,but all were cured and successfally discharged.Through 2-10 months of follow up,all patients have survived with normal hepatic and renal function.Conclusions The use of quadri-immunosuppression,PPE,postoperational infusion of IVIG and prostaglandin E1,splenectomy and De-Escalation of antibiotics may be an effective strategy for ABO-incompatible liver transplantation.

关 键 词：肝移植 ABO血型系统 RH-HR血型系统 血型不相容 

分 类 号：R617[医药卫生—外科学]