血型不合肝移植治疗肝功能衰竭

目的探讨血型不合肝移植治疗肝功能衰竭的可行性和疗效。方法回顾性分析本中心包括21例血型不合在内的66例肝移植治疗肝功能衰竭的临床资料,包括终末期肝病模型（MELD）评分、生存率和主要并发症的发生率。结果血型相同组和血型不合组受体MELD评分分别为31．7±3．2和32．8±2．9,差异无统计学意义（P=0．154）。两组平均生存时间分别为（806．0±70．0）d和（720．3±118．5）d,术后3个月、1年、2年、3年生存率分别为84．2％、77．4％、67．6％、60．1％和75．6％、64．0％、58．2％、58．2％,两组累积生存率差异无统计学意义（P=0．417）。急性排斥反应发生率分别为8．9％（4／45）和19．0％（4／21）,差异无统计学意义（P=0．253）。血型不合组术后感染和胆道并发症发生率分别为76．2％（16／21）和28．6％（6／21）显著高于相同组的48．9％（22／45,P=0．037）和8．9％（4／45,P=0．038）。严重感染和肾功能衰竭是血型不合肝移植术后早期主要死亡原因。结论在血型相同供肝严重短缺的情况下,ABO血型不同肝移植是治疗肝功能衰竭的有效手段。感染和。肾功能衰竭是围手术期最主要死因。合理的免疫抑制治疗、有效控制感染、加强围手术期的管理是提高血型不合肝移植成功率的关键。

ABO-incompatible liver transplantation for liver failure

OBJECTIVE: To evaluate the efficacy of ABO-incompatible orthotopic liver transplantation (OLT) in treatment of liver failure. METHODS: The clinical data of 66 cases of OLT, including 21 cases of ABO-incompatible OLT, for liver failure were retrospectively analyzed. RESULTS: The 3-month, and 1-, 2-, and 3-year survival rates of the ABO-identical group were 84.2%, 77.4%, 67.6%, and 60.1%, respectively, while those of the ABO-incompatible group were 75.6%, 64.0%, 58.2%, and 58.2%, respectively. The mean survival time of the ABO-identical group was (806.0+/-70.0) d, not significantly different from that of the ABO-incompatible group (720.3+/-118.5 d, P=0.417). The acute rejection rate of the ABO-identical group was 8.9%, not significantly different from that of ABO-incompatible group (9.0%, P=0.253). The biliary tract complication rate and infection rate of the ABO-incompatible group were 76.2% and 28.6% respectively, both significantly higher than those of the ABO-identical group (48.9% and 8.9% respectively, P=0.037 and P=0.038). The major causes of death in the ABO-incompatible group were serious infection (5/21) and renal failure (4/21). CONCLUSION: ABO-incompatible OLT is an acceptable option to cure liver failure in emergency. Intensive perioperative supervision is essential to improve the effect of ABO-incompatible OLT.