ABO血型不合肝移植术前脱敏治疗方案的网状荟萃分析  

Different desensitization therapeutic effects on patients with ABO-incompatible liver transplantation: a network-meta analysis

作　　者：黄芳 徐剑 张微[2] 文全 陆路 李仲洋 黄业宁 Huang Fang;Xu Jian;Zhang Wei;Wen Quan;Lu Lu;Li Zhongyang;Huang Yening(Department of Hepatobiliary Surgery,the Second Affiliated Hospial of Hainan Medical University,Haikou 570311,China;Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China)

机构地区：[1]海南医学院第二附属医院肝胆外科,海口570311 [2]浙江大学医学院附属第一医院肝胆胰外科,杭州310003

出　　处：《中华移植杂志（电子版）》2018年第3期131-138,共8页Chinese Journal of Transplantation(Electronic Edition)

基　　金：海南省科学技术厅基金(ZDYF2017162)

摘　　要：目的评价ABO血型不合肝移植(ABO-ILT)术前不同脱敏治疗方案的疗效。方法以利妥昔单抗(Rb)为关键药物,将脱敏治疗方案分为:Rb+全血血浆置换(去除)组(Rb+TPE/PP组)、Rb组、Rb+静脉注射免疫球蛋白组(Rb+IVIG组),以ABO血型相合肝移植受者作为对照组,对比4组不同结局事件。计算机检索Pub Med、EMbase、MEDLINE、Cochrane Library、Scopus、CNKI、Wan Fang Data、VIP数据库。检索年限为2003年1月至2018年5月20日。采用NOS文献质量评价量表评价纳入文献质量。采用Excel 2007软件,加载Net MetaXL宏命令,调用Win BUGS 14. 3软件,选择贝叶斯随机效应模型实现网状荟萃分析。P <0. 05为差异有统计学意义。结果共纳入9篇文献。分别有6、4篇文献报道了不同脱敏治疗方案肝移植受者术后1、3年生存率,3种方案组间对比以及与血型相合肝移植对照组相比,差异均无统计学意义(P均> 0. 05)。9篇文献报道了不同脱敏治疗方案肝移植受者术后抗体介导排斥反应(AMR)和急性细胞排斥反应(ACR)发生率,3组方案组间对比以及与血型相合肝移植对照组对比,差异均无统计学意义(P均> 0. 05);但Rb+TPE/PP组、Rb组和Rb+IVIG组ACR的SUCRA值分别为0. 3562、0. 7767和0. 7092,均高于血型相合肝移植对照组(0. 1579),差异均有统计学意义(P均<0. 05)。分别有8、7篇文献报道了不同脱敏治疗方案肝移植受者术后弥漫性肝内胆管狭窄和非肝内胆道并发症(胆漏、胆道狭窄)发生率,3组方案组间对比以及与血型相合肝移植对照组对比,差异均无统计学意义(P均> 0. 05)。ABO-ILT术前采用不同脱敏治疗方案的受者术后AMR和ACR发生率漏斗图均分布在垂直线周围,无明显不对称,可能不存在小样本效应。结论 Rb脱敏疗效等同于Rb+IVIG及Rb+TPE/PP。若肝移植术前无充分准备时间,可实施Rb+IVIG脱敏治疗;时间充分且受者经济负担重时,可予Rb脱敏治疗。Objective To compare the efficacy of three different desensitization therapies in ABO- incompatible liver transplantation （ABO- ILT） by meta- analysis. Methods The recipients were divided into three groups according to the different desensitization protocal： （rituximab＋TPE/PP） group, rituximab group; （rituximab＋IVIG） group, ABO- compatible liver transplantation （ABO- CLT） group. Different incidence rate of events were compared. Studies published during January 2003 and May 20, 2018 were electronically retrieved from PubMed, EMbase, MEDLINE, Cochrane Library, Scopus, CNKI, WanFang Data, VIP. Newcastle- Ottawa Scale was used to evaluated the the quality of literature. Meta- analysis was performed to calculate OR and 95% confidence interval by using the random effect model analyses with WinBUGS 14.3 software. Statistical significance was approved when P 〈0.05. Results Nine studies were selected. No statistical significance was observed in the postoperative 1- and 3- year survival rate of the recipients, incidence of antibody- mediated rejection （AMR）, incidence of acute cellular rejection （ACR）, incidence of postoperative diffuse intrahepatic biliary stricture and non- intrahepatic biliary tract complications among 4 groups （ P all〉0.05）. The SUCRA value of ACR of （rituximab＋TPE/PP） group, rituximab group, （rituximab＋IVIG） group were 0.3562, 0.7767 and 0.7092, which were all higher than ABO- CLT group （ P all〉0.05）. No small sample effect was observerd among the above desensitization therapies. Conclusions The desensitization therapeutic effects between rituximab combined with TPE/PP and rituximab combined with IVIG was similar. Rituximab combined with IVIG can be perforned for emergent ABO- ILT. Rituximab monotherapy is proper when there is sufficient time and economy burden.

关 键 词：ABO血型不合肝移植 利妥昔单抗 脱敏治疗 网状荟萃分析 

分 类 号：R657.3[医药卫生—外科学]