ABO血型不合肝移植4例临床分析  

ABO-Incompatible Liver Transplantation:A Single Center Experience

作　　者：赵永恒[1] 李立[1] 冉江华[1] 李来邦[1] 李铸[1] 刘静[1] 蒋益舟[1] 吴淑媛[1] 梁宇[1] 刘滇生[1] 

机构地区：[1]昆明市第一人民医院肝胆胰一科,云南昆明650011

出　　处：《中国普外基础与临床杂志》2011年第6期595-598,共4页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨ABO血型不合肝移植的围手术期处理模式。方法回顾性分析2006年7月至2010年5月期间我院非紧急状态下开展的4例ABO血型不合的肝移植患者的临床资料。3例供体为AB型,受体为O型,均诊断乙肝肝硬变、肝功能失代偿,其中1例合并重症肝炎;1例供体为AB型,受体为A型,诊断为原发性肝癌合并乙肝后肝硬变、肝功能失代偿。结果 4例均存活至今（11~19个月）,术后无感染、急性排斥反应发生。2例术后凝血功能障碍、渗血,其中1例二次探查;1例术后出现肾功能不全、少尿,给予床旁持续血浆滤过治疗后恢复正常。所有病例移植肝开放血流前2 h及术后第4天均给予巴利昔单抗20 mg处理,3例同时行脾切除术,4例术后给予1周以上的丙种球蛋白静脉滴注。血型抗体滴度术前1∶32的受体2例,术后第2天即下降并稳定于1∶8;术前1∶4的1例,术后1周内降至1∶2;术前1∶16的1例,术后第2~10周升高后自行降至1∶8。预防应用抗生素和免疫抑制方案与血型相符肝移植基本相同,停用激素时间延迟3个月。结论在供肝紧缺情况下,通过完善围手术期处理,包括IL-2受体单抗、人丙种球蛋白的使用及合理的术后免疫抑制剂方案,结合脾切除术等措施,进行ABO血型不合的肝移植是可行的。Objective To explore perioperative management model of ABO-incompatible liver transplantation.Methods The clinical data of ABO-incompatible caderveric liver transplantions without urgency performed in our center from July 2006 to May 2010 were analyzed retrospectively.Four patients had received an ABO-incompatible graft： AB to O in three,AB to A in one.All the cases were diagnosed as end-stage liver disese,one of them was primary hepatocellular carcinoma.Results Four survived to now（11 to 19 months） without severe infections and acute rejections.Two experienced coagulative disturbance and one of them had a second exploration.One developed acute renal failure and recovered with help under continuous veno-venous hemofiltration.All the cases were given 20 mg basiliximab two hours before revascularization and on day 4 after operation respectively.Splenectomy was performed in three,intravenous immunoglobulin was given in all more than seven days.Isohemagglutinin titers were basically stable and not relevant to the clinical manifestations.Antibiotic prophylaxis and immunosuppression protocol was same as the ABO compatible transplants except a 3-month-delay for steroid withdrawal.Conclusion ABO-incompatible liver transplantation could be performed with appropriate perioperative management,such as basiliximab induction,splenectomy,intravenous immunoglobulin administration,and routine immunosuppression.

关 键 词：肝移植 血型不合 脾切除 免疫抑制 

分 类 号：R657.3[医药卫生—外科学]