小儿血型不合活体肝移植的临床疗效分析  

Clinical efficacy analysis of pediatric blood type incompatible living donor liver transplantation

作　　者：孙超[1] 孟醒初[1] 董冲[1] 王凯[1] 郑卫萍[1] 覃虹[1] 韩潮[1] 杨洋[1] 张复波[1] 曹顺琪 徐敏 高伟[1] Sun Chao;Meng Xingchu;Dong Chong;Wang Kai;Zheng Weiping;Qin Hong;Han Chao;Yang Yang;Zhang Fubo;Cao Shunqi;Xu Min;Gao Wei(Organ Transplantation Center,Tianjin First Central Hospital,Tianjin Key Laboratory of Organ Transplantation,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院器官移植中心天津市器官移植重点实验室,300192

出　　处：《器官移植》2020年第4期466-470,共5页Organ Transplantation

基　　金：天津市卫生行业重点攻关项目(16KG107);天津市器官移植临床医学研究中心项目(15ZXLCSY00070)。

摘　　要：目的探讨小儿血型不合活体肝移植的临床疗效。方法回顾性分析242例小儿活体肝移植受者的临床资料。根据供、受者血型相合情况分为A组(供、受者血型相同,165例)、B组(供、受者血型相合,42例)、C组(供、受者血型不合,35例)。观察并比较3组受者的术后并发症发生情况、术后供体特异性抗体(DSA)产生情况;分析C组供、受者血型分布及红细胞抗体产生情况;比较3组受者肝移植术后的生存情况。结果3组受者并发症发生率比较,差异均无统计学意义(均为P>0.05)。肝移植术后DSA以人类白细胞抗原(HLA)Ⅱ类抗体为主,多为抗HLA-DR和抗HLA-DQ。C组肝移植受者术后红细胞抗体多为IgM,所有抗体滴度均为≤12。3组受者术后生存率差异均无统计学意义(均为P>0.05)。结论小儿血型不合活体肝移植是一种安全有效的治疗方式,可有效扩大肝移植供者来源,挽救患儿生命。Objective To explore the clinical efficacy of pediatric blood type incompatible living donor liver transplantation.Methods The clinical data from 242 cases of pediatric living donor liver transplantation recipients were retrospectively analyzed.Recipients were assigned to group A(ABO-identical group,n=165),group B(ABOcompatible group,n=42)and group C(ABO-incompatible group,n=35)according to the blood type compatibility between the recipients and the donors.The occurrence of postoperative complications and development of postoperative donor specific antibody(DSA)among the 3 groups were observed and compared.And the blood type distribution of donors and recipients and development of erythrocyte antibodies in group C were analyzed.The survival situation of recipients after liver transplantation was compared among the 3 groups.Results There was no significant difference in the incidence of complications among the 3 groups(all P>0.05).DSA was dominated by human leukocyte antigen(HLA)antibodies after liver transplantation,mostly anti-HLA-DR and anti-HLA-DQ.The postoperative erythrocyte antibodies for liver transplant recipients in group C were dominated by IgM,with titers≤12 for all.The differences in postoperative survival rates were not statistically significant among 3 groups(all P>0.05).Conclusions Pediatric blood type incompatible living donor liver transplantation is a safe and effective treatment,which can effectively expand the source of liver transplant donors and save the children's lives.

关 键 词：血型不合 儿童受者 肝移植 供体特异性抗体 红细胞抗体 排斥反应 人类白细胞抗原 

分 类 号：R617[医药卫生—外科学] R457.11[医药卫生—临床医学]