血型不相容肝移植新型策略临床的应用

目的：探讨血型不相容肝移植新型策略运用的疗效。
方法：回顾性分析血型不相容同种异体原位肝移植4例临床资料，4例均为成人ABO血型不相容肝移植，3例AB型供给O型，1例AB型RH（+）供给A型RH（-）。采用术前设定的围术期新策略预防急性排斥反应，包括四联免疫抑制剂、选择性血浆置换、术后输注免疫球蛋白和前列腺素E1、术中切脾、降阶梯策略预防及治疗术后感染。
结果：1例患者术后第3天发生抗体介导的超急性排异反应，经血浆置换联合甲基强的松龙冲击治疗治愈；2例发生急性肾功衰，经床旁血液净化治愈；所有患者术后均发生感染并治愈，全部存活出院，随诊2~10个月，肝肾功正常。
结论：采用四联免疫抑制剂﹑术中切出脾脏﹑选择性血浆置换，输注免疫球蛋白及脂质体前列腺素E1及降阶梯抗感染治疗新策略，也许是提高跨血型肝移植成功率的有效办法之一。

Application of a new strategy in ABO-incompatible liver transplantation

Objective：To evaluate the effectiveness of a new strategy in ABO-incompatible liver transplantation.
Methods：We retrospectively analyzed the clinical records of 4 cases of ABO-incompatible  allogeneic orthotopic liver transplantation performed in our hospital. Among them, 3 blood type O recipients received livers from blood type AB donors, and one type A RH（-）recipient received liver from blood type AB RH（+）donor. A new strategy of perioperative mangement was used for prevention of acute rejection, that included perioperative mangement with quadri-immunosuppressant, PPE, postoperational infusion of IVIG and prostaglandin E1, splenectomy and De-Escalation of antibiotics to prevent and treat postoperative infection.
Results：One patient had antibody-mediated rejection three days after operation and recovered after plasma exchange combined with high dose steroid treatments; 2 patients had acute renal failure and recovered after continuous venovenous hemofiltration(CVVH) for 2 weeks. All patients had infection postoperatively, but all  were cured and successfally discharged. Through 2-10 months of follow up, all patients have survived with normal hepatic and renal function.
Conclusions：The use of quadri-immunosuppression, PPE, postoperational infusion of IVIG and prostaglandin E1, splenectomy and De-Escalation of antibiotics  may be an effective strategy for ABO- incompatible liver transplantation.