目的 探討ABO血型不合的肝移植治療急性肝功能衰竭的療效。
方法 回顧性分析我院急診狀態(tài)下開展的3例(布加綜合征患者1例，肝癌患者1例，重癥乙型肝炎患者1例)ABO血型不合的肝移植患者的臨床資料，術(shù)后以四聯(lián)免疫抑制劑抗排斥反應(yīng)。
結(jié)果 1例布加綜合征患者術(shù)后相繼出現(xiàn)肺部感染、腦橋髓鞘溶解癥及急性排斥反應(yīng)，經(jīng)積極對癥處理后緩解，現(xiàn)已存活14個月； 1例肝癌患者術(shù)后出現(xiàn)不可控制的感染，術(shù)后13 d因多臟器功能衰竭死亡； 1例重癥乙型肝炎患者術(shù)后出現(xiàn)急性腎功能衰竭，給予持續(xù)腎臟替代療法，腎功能恢復(fù)。
結(jié)論 ABO血型不合的肝移植術(shù)后并發(fā)癥多，通過加強(qiáng)圍手術(shù)期管理和應(yīng)用有效的免疫抑制方案，可提高ABO血型不合肝移植的療效。在無合適供體的緊急情況下，ABO血型不合的肝移植可以作為急性肝功能衰竭患者的一個重要選擇。
引用本文： 公偉,劉軍,楊鳳輝,許世峰,周旭,于光圣,徐延田,盧俊. ABO血型不合的肝移植(附3例報道). 中國普外基礎(chǔ)與臨床雜志, 2009, 16(3): 187-190. doi: 復(fù)制
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| 2. | Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [Ｊ]. Lancet, 1990; 336(8714):519. |
| 3. | Reding R, Veyckemans F, de Ville de Goyet J, et al. ABO-incompatible orthotopic liver allografting in urgent indications [Ｊ]. Surg Gynecol Obstet, 1992; 174(1):59. |
| 4. | Farges O, Kalil AN, Samuel D, et al. The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients [Ｊ]. Transplantation, 1995; 59(8):1124. |
| 5. | Wu A, Bühler LH, Cooper DK. ABO-incompatible organ and bone marrow transplantation: current status [Ｊ]. Transpl Int, 2003; 16(5):291. |
| 6. | Rydberg L. ABO-incompatibility in solid organ transplantation [Ｊ]. Transfus Med, 2001; 11(4):325. |
| 7. | Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation [Ｊ]. Transplantation, 2004; 77(3):403. |
| 8. | Takahashi K, Saito K, Takahara S, et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan [Ｊ]. Am J Transplant, 2004; 4(7):1089. |
| 9. | Sugawara Y, Makuuchi M. Adult liver transplantation using live ABO-incompatible grafts in Western countries [Ｊ]. Liver Transpl, 2006; 12(9):1324. |
| 10. | Boberg KM, Foss A, Midtvedt K, et al. ABO-incompatible deceased donor liver transplantation with the use of antigen-specific immunoadsorption and anti-CD20 monoclonal antibody [Ｊ]. Clin Transplant, 2006; 20(2):265. |
| 11. | Koukoutsis I, Bellagamba R, Tamijmarane A, et al. Outcomes after identical and compatible orthotopic liver transplantation for fulminant hepatic failure: a single center experience in UK [Ｊ]. Transpl Int, 2007; 20(8):659. |
| 12. | Mahendran AO, Veitch PS. Paired exchange programmes can expand the live kidney donor pool [Ｊ]. Br J Surg, 2007; 94(6):657. |
| 13. | Toso C, Al-Qahtani M, Alsaif FA, et al. ABO-incompatible liver transplantation for critically ill adult patients [Ｊ]. Transpl Int, 2007; 20(8):675. |
| 14. | Skogsberg U, Breimer ME, Friman S, et al. Adult ABO-incompatible liver transplantation, using A and B donors [Ｊ]. Xenotransplantation, 2006; 13(2):154. |
| 15. | Whiting JF, Fecteau A, Martin J, et al. Use of low-dose OKT3 as induction therapy in liver transplantation [Ｊ]. Transplantation, 1998; 65(4):577. |
| 16. | Hashimoto T, Kondo S, Suzuki T, et al. Strategy for ABO-incompatible living-related liver transplantation [Ｊ]. Transplant Proc, 2000; 32(7):2104. |
| 17. | 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 [Ｊ]. Liver Transpl, 2003; 9(1):22. |
| 18. | Kawagishi N, Satoh K, Enomoto Y, et al. New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (rituximab) and plasma exchange [Ｊ]. Transplant Proc, 2005; 37(2):1205. |
| 19. | 李軍, 竇科峰, 朱靚, 等. 人肝移植術(shù)后移植肝臟熱休克蛋白70的表達(dá)及意義 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(6):426. |
| 20. | 朱新鋒, 陳剛, 張文奪, 等. 肝移植術(shù)后應(yīng)用胸腺肽α1對急性排斥反應(yīng)的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(6):430. |
| 21. | Kozaki K, Egawa H, Kasahara M, et al. Therapeutic strategy and the role of apheresis therapy for ABO incompatible living donor liver transplantation [Ｊ]. Ther Apher Dial, 2005; 9(4):285. |
| 22. | Kozaki K, Egawa H, Ueda M, et al. The role of apheresis therapy for ABO incompatible living donor liver transplantation: the Kyoto University experience [Ｊ]. Ther Apher Dial, 2006; 10(5):441. |
| 23. | 葉啟發(fā), 佘興國, 明英姿, 等. 脾切除對肝移植預(yù)后影響的回顧性探討 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(3):159. |
- 1. Gordon RD, Fung JJ, Iwatsuki S, et al. Immunological factors influencing liver graft survival [Ｊ]. Gastroenterol Clin North Am, 1988; 17(1):53.
- 2. Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers [Ｊ]. Lancet, 1990; 336(8714):519.
- 3. Reding R, Veyckemans F, de Ville de Goyet J, et al. ABO-incompatible orthotopic liver allografting in urgent indications [Ｊ]. Surg Gynecol Obstet, 1992; 174(1):59.
- 4. Farges O, Kalil AN, Samuel D, et al. The use of ABO-incompatible grafts in liver transplantation: a life-saving procedure in highly selected patients [Ｊ]. Transplantation, 1995; 59(8):1124.
- 5. Wu A, Bühler LH, Cooper DK. ABO-incompatible organ and bone marrow transplantation: current status [Ｊ]. Transpl Int, 2003; 16(5):291.
- 6. Rydberg L. ABO-incompatibility in solid organ transplantation [Ｊ]. Transfus Med, 2001; 11(4):325.
- 7. Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation [Ｊ]. Transplantation, 2004; 77(3):403.
- 8. Takahashi K, Saito K, Takahara S, et al. Excellent long-term outcome of ABO-incompatible living donor kidney transplantation in Japan [Ｊ]. Am J Transplant, 2004; 4(7):1089.
- 9. Sugawara Y, Makuuchi M. Adult liver transplantation using live ABO-incompatible grafts in Western countries [Ｊ]. Liver Transpl, 2006; 12(9):1324.
- 10. Boberg KM, Foss A, Midtvedt K, et al. ABO-incompatible deceased donor liver transplantation with the use of antigen-specific immunoadsorption and anti-CD20 monoclonal antibody [Ｊ]. Clin Transplant, 2006; 20(2):265.
- 11. Koukoutsis I, Bellagamba R, Tamijmarane A, et al. Outcomes after identical and compatible orthotopic liver transplantation for fulminant hepatic failure: a single center experience in UK [Ｊ]. Transpl Int, 2007; 20(8):659.
- 12. Mahendran AO, Veitch PS. Paired exchange programmes can expand the live kidney donor pool [Ｊ]. Br J Surg, 2007; 94(6):657.
- 13. Toso C, Al-Qahtani M, Alsaif FA, et al. ABO-incompatible liver transplantation for critically ill adult patients [Ｊ]. Transpl Int, 2007; 20(8):675.
- 14. Skogsberg U, Breimer ME, Friman S, et al. Adult ABO-incompatible liver transplantation, using A and B donors [Ｊ]. Xenotransplantation, 2006; 13(2):154.
- 15. Whiting JF, Fecteau A, Martin J, et al. Use of low-dose OKT3 as induction therapy in liver transplantation [Ｊ]. Transplantation, 1998; 65(4):577.
- 16. Hashimoto T, Kondo S, Suzuki T, et al. Strategy for ABO-incompatible living-related liver transplantation [Ｊ]. Transplant Proc, 2000; 32(7):2104.
- 17. 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 [Ｊ]. Liver Transpl, 2003; 9(1):22.
- 18. Kawagishi N, Satoh K, Enomoto Y, et al. New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (rituximab) and plasma exchange [Ｊ]. Transplant Proc, 2005; 37(2):1205.
- 19. 李軍, 竇科峰, 朱靚, 等. 人肝移植術(shù)后移植肝臟熱休克蛋白70的表達(dá)及意義 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(6):426.
- 20. 朱新鋒, 陳剛, 張文奪, 等. 肝移植術(shù)后應(yīng)用胸腺肽α1對急性排斥反應(yīng)的影響 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(6):430.
- 21. Kozaki K, Egawa H, Kasahara M, et al. Therapeutic strategy and the role of apheresis therapy for ABO incompatible living donor liver transplantation [Ｊ]. Ther Apher Dial, 2005; 9(4):285.
- 22. Kozaki K, Egawa H, Ueda M, et al. The role of apheresis therapy for ABO incompatible living donor liver transplantation: the Kyoto University experience [Ｊ]. Ther Apher Dial, 2006; 10(5):441.
- 23. 葉啟發(fā), 佘興國, 明英姿, 等. 脾切除對肝移植預(yù)后影響的回顧性探討 [Ｊ]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(3):159.