ABO 血型不同的同种异体肺移植患者的 临床处理及救治体会

目的 总结 ABO 血型不同但相容的同种异体肺移植患者的临床处理经验。方法 回顾性分析 2015 年 8 月—9 月天津市第一中心医院心外科完成的 3 例 ABO 血型不同但相容肺移植手术过程。3 例供体均为脑死亡患者， ABO 血型不同但相容，群体反应性抗体（PRA）及淋巴细胞毒交叉配合试验均为阴性。手术方式为左单肺移植和序 贯式双肺移植。移植术后予以常规治疗肺水肿、免疫抑制（吗替麦考酚酯+他克莫司+糖皮质激素的三联免疫抑制治 疗）、抗感染（亚胺培南西司他丁钠+米卡芬净钠+更昔洛韦）等治疗。结果 3 例受者均顺利完成手术，手术时间 5~6 h，冷缺血时间均小于 4 h，术中出血量 800~1 000 mL。3 例患者术后 24 h 内拔除气管插管，胸腔闭式引流管在 72 h 内拔出，ICU 停留时间 5~8 d。术后第 5 周出院，2 例术后第 6 天出现肺部感染，升级抗生素治疗 3 周后痊愈。术后 随访 21~22 个月，3 例均存活且未发生移植物排斥等严重并发症。结论 全面有效的手术技术，合理的供肺选择及 保护方法，积极的抗感染策略和三联免疫抑制方案可以提高移植术后早期存活率。

Clinical treatment and experience of treating allogeneic lung transplantation with different ABO blood groups

Objective To summarize the clinical experience in the treatment of allogeneic lung transplantation with ABO-different donor. Methods Data of three cases of lung transplantation carried out in Tianjin First Central Hospital from August to September 2015 were retrospectively analysed. ABO blood groups were different but compatible in three donors who were with brain death, and their panel reactive antibody (PRA) and lymphocyte poison cross matching test were negative. The surgical approaches were left single-lung transplantation and sequential bilateral single-lung transplantation. After the surgery, measures for pneumonedema control, immuno suppression (mycophenolate mofetil + tacrolimus + glucocorticoids) and anti-infection (imipenem and cilastatin sodium + micafungin sodium + ganciclovir) were carried out. Results The operation wsa completed successfully in all 3 patients, and the operative time was 5-6 hours. The cold ischemia time was less than 4 hours. The blood loss during the operation was 800-1000 mL. The trachea cannula extubation was pulled out within 24 h, thoracic drainage tube was pulled out within 72 h. All the patients were moved into general ward in 5-8 days. Patients discharged from hospital in 5 weeks after operation. Pneumonia infection occurred in 2 cases on the 6 th day after operation, and antibiotic treatment was upgraded and infection was cured after 3 weeks. All patients were followed up for 21-22 months, and 3 patients survived without serious complications such as graft rejection. Conclusion Comprehensive and effective surgical techniques, reasonable choice of donor lung and preservation method, active antiinfection strategy and triple immunosuppressive program can improve the survival rate after transplantation.