肝移植术后抗体介导的排斥反应与胆道狭窄的关系及诊疗策略分析

背景与目的：肝移植术后抗体介导的排斥反应（AMR）相对少见，但AMR是移植后移植物失功能的重要危险因素。本研究探讨肝脏移植术后AMR的发生情况，以及AMR与胆道狭窄的关系及诊疗策略。方法：回顾性分析2016年1月—2023年10月在昆明市第一人民医院接受脑死亡捐献肝移植的203例患者的临床资料。结果：203例肝移植患者中，发生肝移植术后急性排斥反应20例，其中AMR 7例、T细胞介导的急性排斥反应（TCMR） 13例；发生胆道狭窄18例。发生急性排斥的患者中，6例（30.0%）发生胆道狭窄，未发生急性排斥患者中，12例（6.6%）发生胆道狭窄，前者胆道狭窄的发生率明显高于后者（P=0.002）。AMR患者中5例（71.4%）发生胆道狭窄，其中诊断急性AMR时3例患者合并胆道狭窄并处理，2例患者在AMR治疗好转后1年随访过程中出现胆道狭窄；TCMR患者中仅1例（7.7%）于术后3年发生胆道狭窄，AMR患者胆道狭窄的发生率明显高于TCMR患者（P=0.007）。7例AMR患者中，1例在移植术后2个月出现肝功能异常，在1周内快速出现肝功能恶化，经激素冲击治疗无效后因肝功能衰竭并颅内出血死亡；...

Analysis of the relationship between antibody-mediated rejection and biliary strictures following liver transplantation and its diagnosis and treatment strategies

Background and Aims Antibody-mediated rejection (AMR) is relatively uncommon after liver transplantation, but it poses a significant risk factor for graft function loss. This study investigated the occurrence of AMR after liver transplantation, its relationship with biliary strictures, and the associated diagnostic and therapeutic strategies.Methods The clinical data from 203 patients who underwent brain death donation liver transplantation at the First People''s Hospital of Kunming from January 2016 to October 2023 were retrospectively analyzed.Results Among the 203 liver transplant recipients, 20 cases developed acute rejection after transplantation, including 7 cases of AMR and 13 cases of T-cell-mediated acute rejection (TCMR). Additionally, 18 cases had biliary strictures. Among patients with acute rejection, 6 cases (30.0%) developed biliary strictures, while among those without acute rejection, 12 cases (6.6%) developed biliary strictures, indicating a significantly higher incidence in the former group (P=0.002). In the AMR group, 5 cases (71.4%) developed biliary strictures, of whom 3 cases had concomitant biliary strictures at the time of acute AMR diagnosis and were treated accordingly, while 2 cases developed biliary strictures during the one-year follow-up after AMR treatment. Only 1 TCMR patient (7.7%) developed biliary stricture 3 years after operation， the incidence of biliary strictures in AMR patients was significantly higher than in TCMR patients (P=0.007). Among the 7 AMR patients, one experienced rapid deterioration of liver function within two months after transplantation, leading to death despite steroid pulse therapy. The remaining 6 patients, after managing biliary strictures and receiving AMR-specific treatment, showed normalization of liver function.Conclusion AMR after liver transplantation increases the risk of biliary strictures. For patients with acute AMR and concurrent biliary strictures, prompt consideration of AMR diagnosis and corresponding treatment is essential, in addition to ensuring biliary drainage.