RhD阴性患者接受RhD阳性供肝移植  

Liver transplantation between a RhD positive graft to a RhD negative recipient

作　　者：汪根树[1] 李华[1] 张剑[1] 姜楠[1] 汪国营[1] 傅斌生[1] 杨杨[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝脏移植中心,中山大学器官移植研究所,广东省器官移植中心,广州510630

出　　处：《中华肝胆外科杂志》2011年第11期905-908,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：国家重点基础研究发展规划项目（2009CB522404）;十一五科技攻关项目（2008ZX10002-025）;广东省科技计划项目（2008A060202007）

摘　　要：目的探讨RhD阴性患者肝移植时的供肝选择、输血方法和术后免疫抑制方案。方法回顾分析1例RhD阴性O型肝癌患者接受RhD阳性O型供肝的病例资料并复习相关文献。该患者术中输RhD阴性O型红细胞5U、RhD阳性O型血浆3000ml和冷沉淀30U。术后应用他克莫司＋甲基强的松龙免疫抑制方案，1个月后停用甲基强的松龙。结果该患者术后未发生排斥反应和溶血反应，肝功能恢复顺利。术后未检测抗-D抗体。术后9个月肝癌复发，13个月死于肝癌脑转移。结论RhD阴性患者可以接受RhD阳性供肝，疗效满意。术中和术后如需输血，可根据患者有或无抗-D抗体选择输RhD阴性或阳性红细胞和血小板，输血浆和冷沉淀则不受RhD血型限制。术后不用特别加强免疫抑制方案。Objective To investigate the choice of graft, and transfusion and immunosuppressant regimen of a RhD negative recipient in liver transplantation. Methods One RhD negative patient with hepatoeellular carcinoma who received a liver graft from a RhD positive donor was retrospectively studied, and related references were reviewed. During the operation, the patient received five units of RhD negative/O RBC, 3000 ml positive/O plasma and 30 units eryoprecipitate. Taerolimus and prednisone were used to prevent rejection, and prednisone was withdrawn 30d post transplant. Results The patient＇s liver function recovered smoothly, without any acute rejection or hemolytic reaction. Anti-D antibody was not detected. The patient suffered from cancer recurrence 9 months and died of brain metastasis 13 months after transplantation. Conclusions A RhD negative recipient can receive a graft from a RhD positive donor in liver transplantation. The selection of RBC and platelet from RhD negative or positive donors should be based on the result of anti-D antibody test. Plasma and cryoprecipitate can be transfused regardless of Rh type. Enhanced immunosuppressant regimen was unnecessary for these patients.

关 键 词：RhD阴性受者 肝移植 免疫抑制方案 

分 类 号：R657.3[医药卫生—外科学]