双重滤过血浆置换在ABO血型不合肝移植中的应用

目的  观察双重滤过血浆置换(DFPP)清除ABO血型不合肝移植患者血型抗体的效果和安全性。 方法  选取武警总医院2012年1月至2014年12月行ABO血型不合肝移植受者18例，定为血型不合组。术前检测受者的抗A或抗B血型抗体滴度＞1∶16者行DFPP；另选取同期符合输血原则的肝移植受者20例作为对照组。观察ABO血型不合肝移植受者应用DFPP的抗体滴度、血液生化指标变化情况，以及并发症发生情况；比较血型不合组和对照组受者的急性排斥反应发生率和病死率。 结果  18例患者中，15例术前抗A或抗B血型抗体滴度＞1∶16，行DFPP治疗。与DFPP前相比，DFPP后受者血型抗体滴度平均水平明显下降。血液生化检测发现，纤维蛋白原水平在DFPP后显著下降(P=0.0001)。20例次DFPP中，出现低血压3例次，出血3例次，恶心、呕吐1例次，管路凝血1例次，予对症治疗后好转。经DFPP处理过的血型不合组和对照组的急性排斥反应发生率和病死率比较，差异无统计学意义(均为P＞0.05)。 结论  DFPP能安全有效地降低血型抗体水平，减少肝移植术后急性排斥反应发生率，提高移植的成功率。

Application of double filtration plasmapheresis in ABO-incompatible liver transplantation

Objective To observe the clinical efficacy and safety of double filtration plasmapheresis (DFPP) in eliminating blood group antibody in ABO-incompatible patients undergoing liver transplantation. Methods Eighteen recipients with ABO-incompatible liver transplantation in the General Hospital of Chinese People's Armed Police from January 2012 to December 2014 were selected in the ABO-incompatibility group. The recipients with an antibody titer of anti-A or anti-B blood group>1∶16 were scheduled to undergo DFPP. Another 20 recipients eligible for blood transfusion were chosen into the control group. The changes in the antibody titer, blood biochemical parameters and the incidence of complications were observed in recipients with ABO-incompatible liver transplantation. The incidence of acute rejection and mortality rate between the ABO incompatibility group and control group were statistically compared. Results Among 18 patients, 15 with an antibody titer of anti-A or anti-B blood group>1∶16 received DFPP. After DFPP, the mean antibody titer was significantly declined. Detection of blood biochemical parameters indicated that the level of fibrinogen was significantly decreased following DFPP (P=0.0001). Among 20 cases receiving DFPP, 3 cases presented with hypotension, 3 with hemorrhage, 1 with nausea and vomiting, and 1 with coagulation in pipeline. All symptoms were alleviated after effective treatment. The incidence of acute rejection and mortality rate did not significantly differ between the ABO-incompatibility group and control group after DFPP (both P>0.05). Conclusion DFPP can safely and effectively reduce the level of blood group antibody, decrease the incidence of acute rejection after liver transplantation and enhance the success rate of liver transplantation.