联合间充质干细胞简化方案在ABO血型不符肝移植患者中的应用  

Application of simplified protocol combining with mesenchymal stem cell in ABO-incompatible liver transplant patients

作　　者：张英才[1] 姚嘉[1] 邓宜南 陈良[1] 曾凯宁[1] 杨卿[2] 汪国营[1] 傅斌生[1] 张彤[1] 姜楠[1] 易慧敏[3] 汪根树[1] 张剑[1] 易述红[1] 李华[1] 张琪[4] 杨扬[1] 陈规划[1] 

机构地区：[1]中山大学附属第三医院肝脏外科暨肝移植中心,广州510630 [2]中山大学附属第三医院普通外科,广州510630 [3]中山大学附属第三医院外科ICU,广州510630 [4]中山大学附属第三医院细胞基因治疗及临床转化研究中心,广州510630

出　　处：《中华肝脏外科手术学电子杂志》2016年第6期380-384,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81300365;81370555;81370575;81570593);广东省自然科学基金研究团队项目(2015A030312013);广东省科技计划项目(2015B020226004);广州市科技计划项目-健康医疗协同创新重大专项(158100076);中山大学5010计划(2014006)

摘　　要：目的探讨联合间充质干细胞(MSC)简化方案在ABO血型不符肝移植患者中应用的安全性和可行性。方法本前瞻性研究对象为2014年1月至2015年9月在中山大学附属第三医院接受联合MSC简化方案治疗的12例ABO血型不符肝移植患者。其中男10例,女2例;平均年龄(39±13)岁。所有患者或其家属均签署知情同意书,符合医学伦理学规定。采用血浆置换+利妥昔单抗+静脉注射免疫球蛋白+MSC免疫耐受诱导方案(联合MSC简化方案,不包含脾切除和移植物局部灌注)预防抗体介导的排斥反应。观察患者围手术期情况及术后疗效。结果术后死亡3例,其中2例死于多器官功能衰竭,1例死于消化道出血,其余患者均存活。术后发生急性细胞性排斥反应2例,未发生抗体介导的排斥反应;胆道并发症3例,肝动脉狭窄1例,感染6例。结论联合MSC简化方案对预防ABO血型不符肝移植术后抗体介导的排斥反应是安全、有效的。Objective To investigate the safety and feasibility or a simplified protocol combining with mesenchymal stern cell （MSC） in ABO-incompatible （ABO-I） liver transplant patients. Methods Twelve ABO-I liver transplant patient who received the therapy of a simplified protocol combining with MSC in the Third Affiliated Hospital of Sun Yat-sen University between January 2014 and September 2015 were recruited in this prospective study. Ten cases were male and 2 were female, with a mean age of （39±13） years old. The informed consents of all patients or their families were obtained and the local ethical committee approval was received. A immunologic tolerance induction protocol, plasma exchange ＋ rituximab ＋ intravenous immunoglobin ＋ MSC （simplified protocol combining with MSC and without splenectomy and graft local infusion）, was used to prevent the antibody-mediated rejection （AMR） after liver transplantation （LT）. The perioperative condition and postoperative outcome of the patients were observed. Results Three death cases were observed after LT including 2 cases died of multiple organ failure and 1 of gastrointestinal hemorrhage. The other cases survived. Two cases developed acute cellular rejection and no AMR case was observed. Biliary complication was observed in 3 cases, hepatic artery stenosis in 1 case and infection in 6 cases. Conclusion The simplified protocol combining with MSC is safe and effective in preventing the AMR after ABO-I LT.

关 键 词：间质干细胞 肝移植 ABO血型系统 血型不合 免疫抑制法 

分 类 号：R657.3[医药卫生—外科学]