成人活体ABO血型不合肝移植的回顾性分析  

ABO-incompatible adult living donor liver transplantation： a retrospective analysis

作　　者：王维伟[1] 薛焕洲[1] 孙建军[1] 魏思东[1] 赵会博 谢占涛[1] 汤高枫[1] 徐华恩 陈建斌[1] 陈国勇[1] 

机构地区：[1]河南省人民医院肝移植科,郑州450003

出　　处：《中华肝胆外科杂志》2017年第3期154-157,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的分析ABO血型不相容肝移植患者的临床疗效和预后。方法回顾性分析河南省人民医院和郑州人民医院2013年1月至2015年12月收治的7例成人活体间ABO血型不相容肝移植患者的临床资料，分析受者的年龄、性别、原发病、术前和术后抗血型抗体水平、供肝体积／受者标准肝体积、术后并发症发生情况及预后。结果7例受者供肝体积／受者标准肝体积平均为52．0％。4例患者有脾切除史（3例肝移植术中，1例术前）。7例患者均予血浆置换和利妥昔单抗、巴利昔单抗治疗。7例患者术后1个月内无急性排斥反应，术后1年生存率85．7％（6／7）。结论科学评估供受者状态，制定严格的手术方案，术前采用血浆置换，围手术期综合采用利妥昔单抗、巴利昔单抗和静脉输注免疫球蛋白等治疗措施，可使成人活体间ABO血型不相容肝移植受者获得相对满意的预后。Objective To analyze the clinical efficacy and outcomes of adult patients who underwent ABO-ineompatible living donor liver transplantation. Methods The clinical data of 7 patients who underwent ABO-incompatible living donor liver transplantation at the Henan Provincial People＇s Hospital and Zhengzhou People~ Hospital from January 2013 to December 2015 were analyzed retrospectively. Age, gender, primary disease, blood type antibody level, graft volume/standard liver volume （GV/SLV） , postopera- tive complications and prognosis were analyzed. Results The recipients＇ average GV/SLV was 52.0%. There were 4 recipients who underwent splenectomy, including 3 patients who underwent the procedure concurrently, and one patient who underwent the procedure a few years before, the liver transplantation. Seven recipients were treated with plasmapheresis, Rituximab and Basiliximab. No patients experienced acute rejection during the perioperative period, and the 1-year survival rate was 85.7% （6/7）. Conclusion ABO- incompatible liver transplantation in adult living donor can have favorable clinical outcomes using appropriate preoperative evaluation for recipients, optimized surgical procedures, pretransplant plasmapheresis, and perioperative Rituximab, Basiliximab injection and intravenous immunoglobulin administration.

关 键 词：活体肝移植 ABO血型不合 血浆置换 预后 

分 类 号：R657.3[医药卫生—外科学]