ABO血型不合活体肝移植术后疗效的Meta分析

刘强; 罗芳标; 阎雄; 罗诗樵; 杜成友

doi:10.3969/j.issn.1674-7445.2018.04.004

ABO血型不合活体肝移植术后疗效的Meta分析

doi: 10.3969/j.issn.1674-7445.2018.04.004

400016 重庆医科大学附属第一医院肝胆外科

基金项目:

国家临床重点专科建设项目卫办医政函[2012]649号

详细信息

作者简介:
刘强，男，1986年生，硕士，住院医师，研究方向为肝胆肿瘤和器官移植相关研究，Email：doctorliuqiang@126.com

通讯作者:
杜成友，男，1964年生，博士，教授，研究方向为肝胆肿瘤和器官移植相关研究，Email：duchengyou@126.com

中图分类号: R617, R195.1
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- 被引次数: 0
出版历程
- 收稿日期: 2018-04-13
- 网络出版日期: 2021-01-19
- 刊出日期: 2018-07-15

Clinical efficacy of ABO-incompatible living donor liver transplantation: a Meta analysis

Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

More Information

Corresponding author: Du Chengyou,Email：duchengyou@126.com

摘要

摘要: 目的系统评价ABO血型不合活体肝移植（ABO-I LDLT）术后的疗效，并与ABO血型相合活体肝移植（ABO-C LDLT）相比较。方法系统检索国内外多个数据库，收集关于ABO-I LDLT及ABO-C LDLT疗效对比的文献。根据标准筛选文献，并进行文献质量评价，提取数据。采用Rev Man 5.3软件，应用随机效应模型或固定效应模型进行Meta分析。结果检索文献432篇，按纳入标准筛选共纳入6篇英文文献。Meta分析结果表明ABO-I LDLT组与ABO-C LDLT组的受体及移植物术后1、3、5年存活率和排斥反应发生率差异均无统计学意义（均为P≥0.05）；ABO-I LDLT组术后胆道并发症发生率和肝动脉栓塞发生率均高于ABO-C LDLT组，差异均有统计学意义[比值比（OR）=2.08，95%可信区间（CI）1.25～3.45，P=0.005；OR=2.24，95%CI 1.03～4.89，P=0.04）。结论与ABO-C LDLT相比，ABO-I LDLT疗效稍差，但仍是一种可供选择的治疗终末期肝病的有效手段。
- 肝移植 /
- 活体供体 /
- 血型不合 /
- ABO血型系统 /
- Meta分析 /
- 排斥反应 /
- 胆道并发症 /
- 肝动脉栓塞
Abstract: Objective To systematically evaluate the clinical efficacy of ABO-incompatible living donor liver transplantation (ABO-I LDLT) and compare with ABO-compatible LDLT (ABO-C LDLT). Methods A systematic search of multiple databases at home and abroad was conducted to retrieve the literatures related to the statistical comparison of clinical efficacy between ABO-I LDLT and ABO-C LDLT. The literature screening was conducted, the quality of literatures was evaluated and data extraction was performed. Using Rev Man 5.3 software, a Meta-analysis was performed by random effect model or fixed effect model. Results A total of 432 articles were searched, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis demonstrated that there was no significant difference in the postoperative 1-, 3- and 5-year survival rate of the recipients and grafts and the incidence of rejection responses between the ABO-I LDLT and ABO-C LDLT groups (all P≥0.05). The incidence of postoperative biliary complications and hepatic artery embolization in the ABO-I LDLT group was significantly higher than that in the ABO-C LDLT group [odds ratio (OR) =2.08, 95% confidence interval (CI) 1.25-3.45, P=0.005; OR=2.24, 95%CI 1.03-4.89, P=0.04]. Conclusions Compared with the ABO-C LDLT, ABO-I LDLT yields lower clinical efficacy, whereas it is still an effective method for the treatment of end-stage liver disease.
- Liver transplantation /
- Living donor /
- Blood incompatibility /
- ABO blood group system /
- Meta-analysis /
- Rejection response /
- Biliary complication /
- Hepatic artery embolization

HTML全文

图 1 文献的筛选流程

Figure 1. Process of literature screening

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图 2 ABO-I LDLT组与ABO-C LDLT组受体1年存活率比较

Figure 2. Comparison of 1-year survival rate of recipients between ABO-I LDLT group and ABO-C LDLT group

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图 3 ABO-I LDLT组与ABO-C LDLT组受体3年存活率比较

Figure 3. Comparison of 3-year survival rate of recipients between ABO-I LDLT group and ABO-C LDLT group

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图 4 ABO-I LDLT组与ABO-C LDLT组受体5年存活率比较

Figure 4. Comparison of 5-year survival rate of recipients between ABO-I LDLT group and ABO-C LDLT group

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图 5 ABO-I LDLT组与ABO-C LDLT组移植物1年存活率比较

Figure 5. Comparison of 1-year survival rate of grafts between ABO-I LDLT group and ABO-C LDLT group

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图 6 ABO-I LDLT组与ABO-C LDLT组移植物3年存活率比较

Figure 6. Comparison of 3-year survival rate of grafts between ABO-I LDLT group and ABO-C LDLT group

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图 7 ABO-I LDLT组与ABO-C LDLT组移植物5年存活率比较

Figure 7. Comparison of 5-year survival rate of grafts between ABO-I LDLT group and ABO-C LDLT group

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图 8 ABO-I LDLT组与ABO-C LDLT组胆道并发症发生率比较

Figure 8. Figure 8 Comparison of the incidence of biliary complications between ABO-I LDLT group and ABO-C LDLT group

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图 9 ABO-I LDLT组与ABO-C LDLT组排斥反应发生率比较

Figure 9. Comparison of the incidence of rejection between ABO-I LDLT group and ABO-C LDLT group

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图 10 ABO-I LDLT组与ABO-C LDLT组肝动脉栓塞发生率比较

Figure 10. Comparison of the incidence of hepatic artery thrombosis between ABO-I LDLT group and ABO-C LDLT group

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表 1 纳入文献的基本信息及质量评分

Table 1. Basic information and scores of quality assessment of the included articles

研究作者	年份	国家或地区	文献类型	病例收集年份	ABO-I LDLT组		ABO-C LDLT组		NOS评分（分）
研究作者	年份	国家或地区	文献类型	病例收集年份	总例数	受体年龄	总例数	受体年龄	NOS评分（分）
Song GW, et al^[3]	2016	韩国	回顾性队列研究	2008～2013	235	25～68岁	1 301	19～70岁	8
Lee CF, et al^[4]	2015	中国台湾	回顾性队列研究	2006～2013	046	19～67岁	0340	18～70岁	8
Kim JM, et al^[5]	2016	韩国	回顾性队列研究	2010～2013	47	22～65岁	94	20～68岁	8
Bang JB, et al^[6]	2016	韩国	回顾性队列研究	2008～2014	27	31～65岁	114	－	7
Egawa H, et al^[10]	2004	日本	回顾性队列研究	1990～2000	66	3个月～55岁	461	1个月～68岁	7
Kim JD, et al^[11]	2016	韩国	回顾性队列研究	2011～2014	25	35～66岁	157	44岁～57岁	8
－代表研究中未具体提及或难以提取

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