供受体ABO血型不合的肝移植围手术期处理

目的:探讨供受体ABO血型不合肝移植围手术期的处理方法及疗效。方法:回顾性分析我院实施的13例ABO血型不合肝移植的临床资料,对围手术期可能出现的并发症进行针对性预防,主要采用的措施包括血浆置换、术中显微镜下吻合肝动脉和胆道、切除脾脏、四联免疫抑制治疗,以及术后保持氧饱和度>95%、加强抗凝、预防感染等。结果:13例患者中,7例恢复良好,未出现并发症,其余6例患者中有3例出现急性排异反应,4例出现胆道非吻合口狭窄,4例死亡。结论:在供体缺乏而受者病情危急时,进行供受体ABO血型不合的肝移植是可行的,加强围手术期处理,有助于减少术后并发症,提高肝移植的疗效。

The perioperative management of ABO incompatible liver transplantation

Objective： To explore the treatment of ABO-incompatibile orthotopic liver transplantation（OLT） in perioperative period.Methods： Thirteen cases of ABO-incompatible live transplantation were analyzed retrospectively.The prevention managements of ABO-incompatibile OLT in perioperative period were adopted,including plasmapheresis,hepatic artery and biliary duct anastomosis under the microvascular technique,splenectomy,and quadraple immunosuppressive therapy.In addition,the blood oxygen saturation also should be maintained above 95%,and anti-coagulant and anti-infection therapy should be performed in perioperative period.Results： Seven patients recovered smoothly without complications.Postoperative complications included acute rejection in 3 patients,biliary nonanastomotic stricture in 4 patients,and 3 cases died.Conclusion： ABO-incompatible OLT can be adopted when the graft is scarce and emergercy situation due to severe disease,especially,we should enhance the prevention treatment in perioperative period to decrease the complications and improve outcome of patients after ABO-incompatible OLT.