• 海軍總醫(yī)院肝膽外科（北京，100048）;

【摘 要】 目的  報道1例ABO血型不同肝移植術(shù)后并發(fā)急性溶血性貧血的治療經(jīng)驗。 方法  2010年9月對1例肝癌復(fù)發(fā)患者行肝癌射頻消融聯(lián)合同種異體背馱式肝移植術(shù)，供、受者ABO血型分別為O型及A型。術(shù)后第10天發(fā)生急性溶血性貧血，血常規(guī)示血紅蛋白下降至56 g/L，骨髓穿刺檢查提示各系增生活躍，粒紅比0.52∶1，給予免疫抑制劑及輸注O型洗滌紅細胞治療。 結(jié)果  患者一般情況好轉(zhuǎn)，血紅蛋白上升，術(shù)后第34天上升至111 g/L。隨訪12個月，患者血紅蛋白維持在正常范圍。 結(jié)論  對于ABO血型不同但血型相合的肝移植術(shù)后并發(fā)急性溶血性貧血，免疫抑制劑及輸注供體血型的洗滌紅細胞可有效緩解溶血，提高肝移植成功率。

引用本文： 曹衛(wèi)剛,邱寶安. 肝移植術(shù)后并發(fā)急性溶血性貧血一例. 中國修復(fù)重建外科雜志, 2012, 26(3): 365-367. doi: 復(fù)制

1. Bjøro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donor-recipient ABO matching on the outcome after transplantation. Transplantation, 2003, 75(3): 347-353.
2. Uribe M, Buckel E, Ferrario M, et al. ABO-incompatible liver transplantation: a new therapeutic option for patients with acute liver failure in Chile. Transplant Proc, 2005, 37(3): 1567-1568.
3. Urbani L, Mazzoni A, De Simone P, et al. Treatment of antibody-mediated rejection with high-dose immunoglobulins in ABO-incompatible liver transplant recipient. Transpl Int, 2007, 20(5): 467-470.
4. 梁廷波, 湯曉鋒, 王偉林, 等. 肝移植中應(yīng)用ABO血型不合供肝的初步經(jīng)驗. 中華普通外科雜志, 2006, 21(6): 399-402.
5. Wu A, Bühler LH, Cooper DK. ABO-incompatible organ and bone marrow transplantation: current status. Transplant Int, 2003, 16(5): 291-299.
6. Ashizawa T, Matsuno N, Yokoyama T, et al. The role of plasmapheresis therapy for perioperative management in ABO-incompatible adult living donor liver transplantation. Transplant Proc, 2006, 38(10): 3629-3632.
7. Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier. Transplantation, 1994, 58(5): 543-547.
8. Fishbein TM, Emre S, Guy SR, et al. Safe transplantation of blood type A2 livers to blood type O recipients. Transplantation, 1999, 67(7): 1071-1073.
9. Seebach JD, Stussi G, Passwegj R, et al. ABO blood group barrier in allogeneic bone marrow transplantation revisited. Biol Blood Marrow Transplant, 2005, 11(12): 1006-1013.
10. Takahashi K, Saito K, Takahara S, et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan. Am J Transplant, 2004, 4(7): 1089-1096.
11. Hanto DW, Fecteau AH, Alonso MH, et al. ABO-incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation. Liver Transpl, 2003, 9(1): 22-30.
12. Ishida H, Koyama I, Sawada T, et al. Anti-AB titer changes in patients with ABO incompatibility after living related kidney transplantation: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation. Transplantation, 2000, 70(4): 681-685.
13. Shimazu M, Kitajima M. Living donor liver transplantation with special reference to ABO-incompatible grafts and small-for-size grafts. World J Surg, 2004, 28(1): 2-7.
14. Nakamura Y, Matsuno N, Iwamoto H, et al. Successful case of adult ABO-incompatible liver transplantation: benefical effects of intrahepatic artery infusion therapy: a case report. Transplant Proc, 2004, 36(8): 2269-2273.
15. Tanabe M, Shimazu M, Wakabayashi G, et al. Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation. Transplantation, 2002, 73(12): 1959-1961.
16. Egawa H, Ohdan H, Haga H, et al. Current status of liver transplantation across ABO blood-type barrier. J Hepatobiliary Pancreat Surg, 2008, 15(2): 131-138.
17. Yamada Y, Hoshino K, Morikawa Y, et al. Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia. J Pediatr Surg, 2006, 41(12): 1976-1979.
18. Yoshizawa A, Sakamoto S, Ogawa K, et al. New protocol of immunosuppression for liver transplantation across ABO barrier: the use of Rituximab, hepatic arterial infusion, and preservation of spleen. Transplant Proc, 2005, 7(4): 1718-1719.
19. 楊揚, 許赤, 陳穎華, 等. 血型不合肝移植治療肝功能衰竭. 中華醫(yī)學(xué)雜志, 2007, 87(40): 2833-2836.
  1. 1. Bjøro K, Ericzon BG, Kirkegaard P, et al. Highly urgent liver transplantation: possible impact of donor-recipient ABO matching on the outcome after transplantation. Transplantation, 2003, 75(3): 347-353.
  2. 2. Uribe M, Buckel E, Ferrario M, et al. ABO-incompatible liver transplantation: a new therapeutic option for patients with acute liver failure in Chile. Transplant Proc, 2005, 37(3): 1567-1568.
  3. 3. Urbani L, Mazzoni A, De Simone P, et al. Treatment of antibody-mediated rejection with high-dose immunoglobulins in ABO-incompatible liver transplant recipient. Transpl Int, 2007, 20(5): 467-470.
  4. 4. 梁廷波, 湯曉鋒, 王偉林, 等. 肝移植中應(yīng)用ABO血型不合供肝的初步經(jīng)驗. 中華普通外科雜志, 2006, 21(6): 399-402.
  5. 5. Wu A, Bühler LH, Cooper DK. ABO-incompatible organ and bone marrow transplantation: current status. Transplant Int, 2003, 16(5): 291-299.
  6. 6. Ashizawa T, Matsuno N, Yokoyama T, et al. The role of plasmapheresis therapy for perioperative management in ABO-incompatible adult living donor liver transplantation. Transplant Proc, 2006, 38(10): 3629-3632.
  7. 7. Lo CM, Shaked A, Busuttil RW. Risk factors for liver transplantation across the ABO barrier. Transplantation, 1994, 58(5): 543-547.
  8. 8. Fishbein TM, Emre S, Guy SR, et al. Safe transplantation of blood type A2 livers to blood type O recipients. Transplantation, 1999, 67(7): 1071-1073.
  9. 9. Seebach JD, Stussi G, Passwegj R, et al. ABO blood group barrier in allogeneic bone marrow transplantation revisited. Biol Blood Marrow Transplant, 2005, 11(12): 1006-1013.
  10. 10. Takahashi K, Saito K, Takahara S, et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan. Am J Transplant, 2004, 4(7): 1089-1096.
  11. 11. Hanto DW, Fecteau AH, Alonso MH, et al. ABO-incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation. Liver Transpl, 2003, 9(1): 22-30.
  12. 12. Ishida H, Koyama I, Sawada T, et al. Anti-AB titer changes in patients with ABO incompatibility after living related kidney transplantation: survey of 101 cases to determine whether splenectomies are necessary for successful transplantation. Transplantation, 2000, 70(4): 681-685.
  13. 13. Shimazu M, Kitajima M. Living donor liver transplantation with special reference to ABO-incompatible grafts and small-for-size grafts. World J Surg, 2004, 28(1): 2-7.
  14. 14. Nakamura Y, Matsuno N, Iwamoto H, et al. Successful case of adult ABO-incompatible liver transplantation: benefical effects of intrahepatic artery infusion therapy: a case report. Transplant Proc, 2004, 36(8): 2269-2273.
  15. 15. Tanabe M, Shimazu M, Wakabayashi G, et al. Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation. Transplantation, 2002, 73(12): 1959-1961.
  16. 16. Egawa H, Ohdan H, Haga H, et al. Current status of liver transplantation across ABO blood-type barrier. J Hepatobiliary Pancreat Surg, 2008, 15(2): 131-138.
  17. 17. Yamada Y, Hoshino K, Morikawa Y, et al. Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia. J Pediatr Surg, 2006, 41(12): 1976-1979.
  18. 18. Yoshizawa A, Sakamoto S, Ogawa K, et al. New protocol of immunosuppression for liver transplantation across ABO barrier: the use of Rituximab, hepatic arterial infusion, and preservation of spleen. Transplant Proc, 2005, 7(4): 1718-1719.
  19. 19. 楊揚, 許赤, 陳穎華, 等. 血型不合肝移植治療肝功能衰竭. 中華醫(yī)學(xué)雜志, 2007, 87(40): 2833-2836.