留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

双重滤过血浆置换在ABO血型不合肝移植中的应用

周婧 雷联会 田二云 杨洋 尹丽华

周婧, 雷联会, 田二云, 等. 双重滤过血浆置换在ABO血型不合肝移植中的应用[J]. 器官移植, 2016, 7(4): 283-286. doi: 10.3969/j.issn.1674-7445.2016.04.007
引用本文: 周婧, 雷联会, 田二云, 等. 双重滤过血浆置换在ABO血型不合肝移植中的应用[J]. 器官移植, 2016, 7(4): 283-286. doi: 10.3969/j.issn.1674-7445.2016.04.007
Zhou Jing, Lei Lianhui, Tian Eryun, et al. Application of double filtration plasmapheresis in ABO-incompatible liver transplantation[J]. ORGAN TRANSPLANTATION, 2016, 7(4): 283-286. doi: 10.3969/j.issn.1674-7445.2016.04.007
Citation: Zhou Jing, Lei Lianhui, Tian Eryun, et al. Application of double filtration plasmapheresis in ABO-incompatible liver transplantation[J]. ORGAN TRANSPLANTATION, 2016, 7(4): 283-286. doi: 10.3969/j.issn.1674-7445.2016.04.007

双重滤过血浆置换在ABO血型不合肝移植中的应用

doi: 10.3969/j.issn.1674-7445.2016.04.007
详细信息
    通讯作者:

    雷联会,Email:leilianhui@163.com

  • 中图分类号: R617,R446.11,R392.4

Application of double filtration plasmapheresis in ABO-incompatible liver transplantation

  • 摘要:   目的  观察双重滤过血浆置换(DFPP)清除ABO血型不合肝移植患者血型抗体的效果和安全性。   方法  选取武警总医院2012年1月至2014年12月行ABO血型不合肝移植受者18例,定为血型不合组。术前检测受者的抗A或抗B血型抗体滴度>1∶16者行DFPP;另选取同期符合输血原则的肝移植受者20例作为对照组。观察ABO血型不合肝移植受者应用DFPP的抗体滴度、血液生化指标变化情况,以及并发症发生情况;比较血型不合组和对照组受者的急性排斥反应发生率和病死率。   结果  18例患者中,15例术前抗A或抗B血型抗体滴度>1∶16,行DFPP治疗。与DFPP前相比,DFPP后受者血型抗体滴度平均水平明显下降。血液生化检测发现,纤维蛋白原水平在DFPP后显著下降(P=0.0001)。20例次DFPP中,出现低血压3例次,出血3例次,恶心、呕吐1例次,管路凝血1例次,予对症治疗后好转。经DFPP处理过的血型不合组和对照组的急性排斥反应发生率和病死率比较,差异无统计学意义(均为P>0.05)。   结论  DFPP能安全有效地降低血型抗体水平,减少肝移植术后急性排斥反应发生率,提高移植的成功率。

     

  • 表  1  ABO血型不合肝移植受者应用DFPP前后血液生化指标的变化

    Table  1.   Changes of blood biochemical indexes before and after application of DFPP in liver transplant recipients with ABO-incompatibility(x±s)

    指 标 n 分子量(D) DFPP前 DFPP后 P
    血尿素氮(mmol/L) 15 60 6.8±1.2 6.4±2.1 0.4641
    丙氨酸转氨酶(U/L) 15 55 000 289±42 279±38 0.4476
    总胆红素(μmol/L) 15 58 000 179±34 172±21 0.4488
    白蛋白(g/L) 15 66 458 31.5±2.3 30.4±2.5 0.1558
    纤维蛋白原(g/L) 15 340 000 212±13 168±19 0.0001
    下载: 导出CSV
  • [1] 沈中阳,邓永林,郑虹,等.ABO血型不合肝移植治疗急危重症肝病患者的临床疗效分析[J].中华危重病急救医学,2014,26(8):529-533.

    Shen ZY, Deng YL, Zheng H, et al. Analysis of the curative effect of ABO-incompatible liver transplantation in the treatment in patients with acute severe liver disease[J]. Chin Crit Care Med, 2014,26(8):529-533.
    [2] 阎冰,李捷,郭文治,等. ABO血型不合肝移植术后急性抗体介导的排斥反应研究进展[J/CD].中华肝脏外科手术学电子杂志,2014,3(2):124-126.

    Yan B, Li J, Guo WZ, et al. Research progress on antibody mediated rejection after liver transplantation with ABO-incompatibility[J/CD]. Chin J Hepatic Surg(Electr Edit),2014,3(2):124-126.
    [3] 吴李贤, 叶一农, 何宏亮,等. 血浆置换联合持续性血液透析滤过治疗肝衰竭的疗效分析[J]. 热带医学杂志, 2014, 14(4):481-484. http://www.cnki.com.cn/Article/CJFDTOTAL-RDYZ201404021.htm

    Wu LX, Ye YN, He HL, et al. Effect of plasma exchange combined with continuous hemodiafiltration on the treatment of liver failure[J]. J Trop Med, 2014, 14(4):481-484. http://www.cnki.com.cn/Article/CJFDTOTAL-RDYZ201404021.htm
    [4] Lumlertgul D, Suteeka Y, Tumpong S, et al. Double filtration plasmapheresis in different diseases in Thailand[J]. Ther Apher Dial,2013,17(1):99-116. doi: 10.1111/tap.2013.17.issue-1
    [5] Tanabe K. Double-filtration plasmapheresis[J]. Transplantation, 2007,84(12 Suppl):S30-S32. http://cn.bing.com/academic/profile?id=2033562197&encoded=0&v=paper_preview&mkt=zh-cn
    [6] Tsai MK, Wu MS, Yang CY, et al. B cells and immunoglobulin in ABO-incompatible renal transplant patients receiving rituximab and double filtration plasmapheresis[J]. J Formos Med Assoc,2015,114(4):353-358. doi: 10.1016/j.jfma.2012.12.012
    [7] Thorsen T, Dahlgren US, Aandahl EM, et al. Liver transplantation with deceased ABO-incompatible donors is life-saving but associated with increased risk of rejection and post-transplant complications[J]. Transpl Int,2015,28(7):800-812. doi: 10.1111/tri.12552
    [8] Demetris AJ, Zeevi A, O'Leary JG. ABO-compatible liver allograft antibody-mediated rejection: an update[J]. Curr Opin Organ Transplant,2015,20(3):314-324. doi: 10.1097/MOT.0000000000000194
    [9] Shen T, Lin BY, Jia JJ, et al. A modified protocol with rituximab and intravenous immunoglobulin in emergent ABO-incompatible liver transplantation for acute liver failure[J]. Hepatobiliary Pancreat Dis Int,2014,13(4):395-401. doi: 10.1016/S1499-3872(14)60268-X
    [10] Tiwari AK, Pandey P, Aggarwal G, et al. Cascade plasmapheresis (CP) as a preconditioning regime in ABO-incompatible live related donor liver transplants (ABOi-LDLT)[J]. Transplant Res,2014, 3 :17. doi: 10.1186/2047-1440-3-17
    [11] 江春平,丁义涛,徐庆祥,等.ABO血型不合供肝在肝移植中的应用[J/CD].实用器官移植电子杂志, 2013, 1 (1):27-30.

    Jiang CP, Ding YT, Xu QX, et al. Application of liver grafts from ABO incompatible donor[J/CD]. Pract J Organ Transplant (Electr Vers) , 2013, 1 (1):27-30.
    [12] Kim JM, Kwon CH, Joh JW, et al. ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor[J]. J Hepatol,2013,59(6):1215-1222. doi: 10.1016/j.jhep.2013.07.035
    [13] Abe M, Sannomiya A, Koike T, et al. Removal of anti-donor antibody by double-filtration plasmapheresis to prevent chronic rejection in kidney transplantation[J]. Transplant Proc,1998,30(7):3108-3109. doi: 10.1016/S0041-1345(98)00952-X
    [14] 陈立中, 陈国栋. ABO血型不相容活体肾移植的热点评析[J]. 器官移植, 2013, 4(4):187-190. http://www.organtranspl.com/browse/detail/qkid/65/id/346.html

    Chen LZ, Chen GD. ABO-incompatible living donor kidney transplantation[J]. Organ Transplant, 2013, 4(4):187-190. http://www.organtranspl.com/browse/detail/qkid/65/id/346.html
    [15] Sanada Y, Mizuta K, Urahashi T, et al. Role of apheresis and dialysis in pediatric living donor liver transplantation: a single center retrospective study[J]. Ther Apher Dial,2012,16(4):368-375. doi: 10.1111/tap.2012.16.issue-4
    [16] Hanafusa N1, Hamasaki Y, Kawarasaki H, et al. The effect of different apheresis modalities on coagulation factor XIII level during antibody removal in ABO-blood type incompatible living related renal transplantation[J]. Transfus Apher Sci,2013,49(2):254-258. doi: 10.1016/j.transci.2013.06.004
  • 加载中
表(1)
计量
  • 文章访问数:  61
  • HTML全文浏览量:  97
  • PDF下载量:  16
  • 被引次数: 0
出版历程
  • 收稿日期:  2016-04-02
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2016-07-15

目录

    /

    返回文章
    返回