供者特异性抗体对儿童肝移植预后的影响  

Effect of DSA on the prognosis of pediatric liver transplantation

作　　者：肖艳丽 李西川[1] 刘伟[2] 刘纯[2] 康中玉 孙超[2,3] 马楠 李代红[2] XIAO Yanli;LI Xichuan;LIU Wei;LIU Chun;KANG Zhongyu;SUN Chao;MA Nan;LI Daihong(Tianjin Medical University,Tianjin 300070,China;不详)

机构地区：[1]天津医科大学,天津300070 [2]天津市第一中心医院 [3]天津市器官移植重点实验室

出　　处：《山东医药》2021年第12期32-36,共5页Shandong Medical Journal

摘　　要：目的观察供者特异性抗体(DSA)对儿童肝移植预后的影响。方法50例肝移植患儿按照DSA有无分为阳性组(24例)、阴性组(26例),比较两组移植肝纤维化、肝功能指标、产生DSA时的随访时间、患儿存活率、并发症。结果阳性组移植肝纤维化12例(50.0%),阴性组移植肝纤维化4例(15.4%),两组比较,P>0.05。阳性组、阴性组血清ALT水平分别为24.40(18.45~73.73)、19.00(17.90~65.00)U/L,血清AST水平分别为46.50(31.00~54.00)、33.80(27.33~51.78)U/L,血清ALP水平分别为201.50(178.25~338.50)、232.10(136.67~338.42)U/L,血清GGT水平分别为14.50(11.25~26.25)、11.20(7.23~23.11)U/L,血清TBA水平分别为8.00(7.08~10.50)、9.11(5.00~25.03)μmol/L,两组血清AST水平比较,P<0.05。阳性组、阴性组产生抗体时的随访时间分别为43、17个月,两组比较,P<0.05。阳性组、阴性组术后1年的存活率分比为91.7%(22/24)和96.2%(25/26),两组比较,P>0.05。阳性组并发症为抗体介导的排斥反应1例,胆管并发症2例,慢性排斥反应2例,TCMR 3例,药物性肝损伤4例;阴性组并发症为慢性排斥反应1例,TCMR 2例,药物性肝损伤4例,血管并发症5例,胆道并发症5例,感染5例。结论肝移植后DSA对于受者的临床影响和预后有一定的影响,因此需要术后定期监测HLA抗体,同时加强术后长期随访管理。进行DSA与病理学结果的分析,思考如何共同利用DSA和其他指标,早期预防排斥反应,或监测DSA阳性肝移植受者制定合理的治疗措施,增加肝移植受者生存时间。Objectives To observe the effect of donor-specific antibody(DSA)on the prognosis of pediatric liver transplantation.Methods Fifty children with liver transplantation were divided into the positive group(n=24)and the negative group(n=26)according to the presence of DSA.The liver fibrosis,liver function index,follow-up time at the presence of DSA,survival rate and complications were compared between the two groups.Results There were 12 cases of transplanted liver fibrosis in the positive group(50.0%)and 4 cases in the negative group(15.4%).There was no significant difference between the two groups.The levels of serum ALT,AST and ALP were 24.40(18.45-73.73)U/L,46.50(31.00-54.00)U/L,and 201.50(178.25-338.50)U/L,respectively,in the positive group versus 19.00(17.90-65.00)U/L,33.80(27.33-51.78)U/L,and 232.10(136.67-338.42)U/L,respectively,in the negative group.The levels of serum GGT in the two group were 14.50(11.25-26.25)U/L and 11.20(7.23-23.11)U/L,respectively.The levels of serum TBA in the two group were 8.00(7.08-10.50)mol/L and 9.11(5.00-25.03)mol/L,respectively.The follow-up time was 43 and 17 months when the children producted antibodies in the positive group and the negative group,respectively,and there was difference between the two groups.The 1-year survival rates of the children in the positive group and the negative group were 91.7%(22/24)and 96.2%(25/26),respectively,and there was no significant difference between the two groups(P>0.05).In the positive group,there were 1 case of antibody-mediated rejection,2 cases of biliary complications,2 cases of chronic rejection,3 cases of T-Cell mediated rejection(TCMR)and 4 cases of drug-induced liver injury,while in the negative group,there were 1 case of chronic rejection,2 cases of TCMR,4 cases of drug-induced liver injury,5 cases of vascular complications,5 cases of biliary complications and 5 cases of infection.Conclusion DSA after liver transplantation has a certain influence on the clinical and prognosis of the recipients,so it is necessary to monitor HLA a

关 键 词：供体特异性抗体 人类白细胞抗原 肝移植手术 排斥反应 患儿生存率 

分 类 号：R617[医药卫生—外科学]