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韩环立, 戴小科, 李英存, 等. ABO血型不相容儿童活体肝移植临床分析[J]. 四川大学学报(医学版), 2022, 53(5): 777-781. DOI: 10.12182/20220960201
引用本文: 韩环立, 戴小科, 李英存, 等. ABO血型不相容儿童活体肝移植临床分析[J]. 四川大学学报(医学版), 2022, 53(5): 777-781. DOI: 10.12182/20220960201
HAN Huan-li, DAI Xiao-ke, LI Ying-cun, et al. Clinical Analysis of ABO-Incompatible Living-Donor Liver Transplantation in Children[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(5): 777-781. DOI: 10.12182/20220960201
Citation: HAN Huan-li, DAI Xiao-ke, LI Ying-cun, et al. Clinical Analysis of ABO-Incompatible Living-Donor Liver Transplantation in Children[J]. Journal of Sichuan University (Medical Sciences), 2022, 53(5): 777-781. DOI: 10.12182/20220960201

ABO血型不相容儿童活体肝移植临床分析

Clinical Analysis of ABO-Incompatible Living-Donor Liver Transplantation in Children

  • 摘要:
      目的  评价ABO血型不相容的供肝在儿童活体肝脏移植中应用的安全性和临床疗效。
      方法  回顾性分析2019年4月–2020年7月于我院完成的62例首次儿童活体肝移植患儿临床资料。根据供体与受体ABO血型匹配情况分为3组:ABO血型相同(ABO-Id)组33例;ABO血型不同但相容(ABO-C)组10例;ABO血型不相容(ABO-In)组19例,3组中位年龄均为5月龄。ABO血型不相容组中4例受体因合并肝功能衰竭、2例受体因血型抗体效价≥1∶32,术前予以血浆置换。所有ABO血型不相容受体术前血型抗体效价<1∶32。3组受体均采用背驮式肝移植术,均接受免疫抑制治疗和抗凝治疗。术后随访截止2020年12月31日或死亡日期,随访时间为5~20个月(中位数12个月)。分析3组受体基础临床资料、术后生存情况以及术后并发症。
      结果  3组受体移植月龄、性别、基础疾病、手术史、Child-Pugh评分、供者年龄、移植物与受者质量比(graft to recipient weight ratio, GR/WR)、冷缺血时间、热缺血时间、手术时间、术中出血、免疫抑制剂使用情况比较,差异均无统计学意义(均P>0.05)。ABO-Id组围手术期死亡1例,术后死亡2例。ABO-C组术后死亡1例。ABO-In组围手术期死亡1例,术后死亡1例。3组受体整体累积生存率比较差异无统计学意义(P>0.05)。3组术后感染、急性排斥反应、胆道吻合口狭窄以及血管并发症的发生率差异均无统计学意义(P>0.05)。
      结论  儿童ABO血型不相容活体肝移植是一种安全有效的治疗手段,可有效增加供肝来源,挽救终末期肝病患儿的生命。

     

    Abstract:
      Objective  To evaluate the safety and clinical efficacy of ABO-incompatible living-donor liver transplantation (LDLT) in children.
      Methods  The clinical data of 62 children who underwent for the first time living donor liver transplantation in our hospital from April 2019 to July 2020 were retrospectively analyzed. According to the blood type matching of donor and recipient, the patients were divided into 3 groups, ABO-identical (ABO-Id, n=33), ABO-compatible (ABO-C, n=10) and ABO-incompatible (ABO-In, n=19), the median age of recipients in the three groups being 5 months. In the ABO-In group, 4 recipients whose condition was combined with liver failure and 2 recipients who had blood group antibody titers≥1∶32 received preoperative plasma exchange. All ABO-incompatible recipients had preoperative blood group antibody titers<1∶32. All recipients in the three groups underwent piggyback liver transplantation and received immunosuppressive and anticoagulation therapy. Postoperative follow-up was 5 to 20 months, the median being 12 months, measured until December 31, 2020 or until the date of death. Baseline clinical data, postoperative survival, and postoperative complications of recipients in the three groups were analyzed.
      Results   There were no significant differences in age, gender, underlying disease, operation history, Child Pugh score, donor age, graft to recipient weight ratio (GR/WR), cold ischemia time, warm ischemia time, duration of surgery, intraoperative blood loss and the use of immunosuppressants among the recipients in the three groups (all P>0.05). There was one death in the perioperative period and two deaths in the postoperative period in the ABO-Id group. There was one death in the postoperative period in the ABO-C group. There was one death in the perioperative period and one death in the postoperative period in the ABO-In group. There was no significant difference in the overall cumulative survival rate among the three groups (P>0.05). There were no significant differences in the incidence of postoperative infection, acute rejection, biliary anastomotic stenosis and vascular complications among the three groups (P>0.05).
      Conclusion   ABO-In LDLT is an effective and safe treatment option that can effectively expand the pool of live donors for liver transplantation and save the life of children with end-stage liver disease.

     

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