Rituximab+IVIG方案预防儿童ABO血型不相容肝移植血型抗体介导排斥反应效果的临床研究  

Clinical research of effect of Rituximab+IVIG regimen to prevent pediatric ABO incompatible living donor liver transplantation

作　　者：曲伟[1,2] 朱志军 魏林[2] 孙丽莹 曾志贵 刘颖 王君 檀玉乐[2] 张晋平[2] QU Wei;ZHU Zhijun;WEI Lin;SUN Liying;ZENG Zhigui;LIU Ying;WANG Jun;TAN Yule;ZHANG Jinping(Liver Transplantation Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,P.R.China;Clinical Center for Pediatric Liver Transplantation,National Clinical Research Center of Digestive Diseases,Capital Medical University,Beijing 100050,P.R.China)

机构地区：[1]首都医科大学附属北京友谊医院肝脏移植中心,北京100050 [2]首都医科大学儿童肝脏移植临床诊疗与研究中心国家消化系统疾病临床研究中心,北京100050

出　　处：《中国普外基础与临床杂志》2021年第8期987-991,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：首都医科大学附属北京友谊医院科研启动基金(项目编号:yyqdkt2019-27)。

摘　　要：目的探索Rituximab+静脉免疫球蛋白(IVIG)联合方案预防儿童ABO血型不相容活体肝移植(ABO incompatible living donor liver transplantation,ABOi-LDLT)术后血型抗体介导的排斥反应(AMR)的临床效果。方法回顾性收集首都医科大学附属北京友谊医院于2013年6月至2020年12月期间施行的儿童活体肝移植503例次,比较ABOi-LDLT与ABO血型相容活体肝移植(ABOc-LDLT)患儿的总生存和移植物生存情况;总结7例接受Rituximab+IVIG联合方案患儿肝移植后的AMR发生情况。结果共纳入儿童ABOi-LDLT 53例(53例次)和ABOc-LDLT 450例次。ABOi-LDLT组受者肝移植术后的5年累积生存率为98.0%,移植物的5年累积生存率为96.0%,ABOc-LDLT组分别为92.2%和89.1%,2组比较差异均无统计学意义(P=0.232,P=0.381)。7例患儿接受Rituximab+IVIG联合方案,术前预存血型抗体滴度>1∶64。6例患儿术后血型抗体滴度持续稳定,未出现排斥反应;1例患儿出现严重AMR,移植物功能衰竭,行再次ABOc-LDLT挽救治疗后痊愈。结论 Rituximab+IVIG联合方案可以作为预防儿童ABOi-LDLT后AMR的有效治疗选择。Objective To observe the clinical effect of Rituximab combined with intravenous immunoglobulin(IVIG)in preventing blood group antibody mediated rejection(AMR)in pediatric ABO incompatible living donor liver transplantation(ABOi-LDLT).Methods A total of 503 cases of pediatric living donor liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were retrospectively collected;the overall survival of recipient and graft were compared between ABOi-LDLT and ABO compatible living donor liver transplantation(ABOc-LDLT),and we summarized the data of AMR in 7 cases received Rituximab+IVIG protocol.Results There were 53 cases of ABOi-LDLT and 450 cases of ABOc-LDLT in our study.The 5-year cumulative survival rate of recipients and grafts was 98.0%and 96.0%in the ABOi-LDLT group respectively,and in ABOc-LDLT group was 92.2%and 89.1%respectively,there was no significant difference between the two groups(P=0.232,P=0.381).Seven children with blood group antibody titer>1∶64 were included in the study.On the basis of classical intensive immunosuppressive therapy,all patients were treated with Rituximab+IVIG.The blood group antibody titer of 6 patients remained stable,and no rejection occurred;one patient developed severe AMR and graft failure,and recovered after salvage treatment of ABOc-LDLT.Conclusion Rituximab+IVIG can be used as an effective therapeutic option to prevent blood group AMR after ABOi-LDLT.

关 键 词：ABO血型不相容活体肝移植 利妥昔单抗 静脉免疫球蛋白 血型抗体介导的排斥反应 

分 类 号：R726.5[医药卫生—儿科] R457.13[医药卫生—临床医学]