活体肝移植与尸肝移植急性细胞排斥反应的比较

目的 比较活体肝移植（LDLT）与尸肝移植（CLT）急性细胞排斥反应（ACR）的发生率及严重程度。方法 将116例病人分为两大组，LDLT组51例（其中供受体有血缘关系者30例），CLT组65例。收集的临床资料包括肝移植物冷缺血时间、基础免疫抑制剂的应用、ACR发生次数及对激素治疗的反应、供受体HLA配型、肝移植物及病人存活情况。结果 CLT组及LDLT组移植物存活率、病人存活率、ACR发生率、ACR多次发生率、对激素治疗无效率分别是72％和78％、77％和78％、48％和41％、20％和10％、11％和4％（两组比较P＞0．05）。有血缘关系者间的肝移植与尸肝移植比较ACR的发生率差异无显著意义。在发生与不发生ACR的病人间HLA位点不合数差异亦无显著意义。以FK506为主的二联免疫治疗方案能减少ACR的发生（P＜0．01）。结论 活体肝移植与尸肝移植ACR的发生率差异无显著意义。供受体HLA配型及移植物冷缺血时间长短与ACR无关。而FK506预防ACR的效果明显优于环孢霉素A。

Comparison of acute cellular rejection between living donor liver transplantation and cadaveric liver transplantation

Objective To compare the incidence and severity of acute cwellular rejection (ACR) between living donor liver treansplantation (LDLT) and cadaveric liver transplantation (CLT). Methods 51 patients underwent LDLT among which 30 received the liver of blood related donors, and 65 patients underwent CLT. Clinical data, such as the cold ischemic time of liver graft, use of immunosuppressive agents, ACR rate, response to steroid therapy, HLA matching between donor and recipient, and survival rates of liver graft and patients were collected and analyzed. Results The graft survival rate, patient survival rate, ACR rate, ACR multiple incidence rate, and no response rate to steroid therapy in CLT and LDLT groups were 72% vs 78%, 77% vs. 78%, 48% vs. 41%, 20% vs. 10%, and 11% vs. 4% ( P >0.05). The difference of ACR rates between CLT and living blood related donor liver transplantation was statistically insignificant. There was no significant difference in number of HLA allele mismatching between patients with ACR and those without ACR. The combined immunosuppression therapy rely mainly on FK506 use reduced the occurrence of ACR ( P <0.05). Conclusion There is no marked difference in incidence of ACR between LDLT and CLT. ACR in liver transplantation is correlated to neither HLA matching between donors and recipients nor to cold ischemic time of the liver graft. FK506 avoids ACR better than cyclosporin2 A.