小儿血型不合活体肝移植的临床疗效分析

Clinical efficacy analysis of pediatric blood type incompatible living donor liver transplantation

    摘要
  • 摘要:
      目的  探讨小儿血型不合活体肝移植的临床疗效。
      方法  回顾性分析242例小儿活体肝移植受者的临床资料。根据供、受者血型相合情况分为A组（供、受者血型相同，165例）、B组（供、受者血型相合，42例）、C组（供、受者血型不合，35例）。观察并比较3组受者的术后并发症发生情况、术后供体特异性抗体（DSA）产生情况；分析C组供、受者血型分布及红细胞抗体产生情况；比较3组受者肝移植术后的生存情况。
      结果  3组受者并发症发生率比较，差异均无统计学意义（均为P > 0.05）。肝移植术后DSA以人类白细胞抗原（HLA）Ⅱ类抗体为主，多为抗HLA-DR和抗HLA-DQ。C组肝移植受者术后红细胞抗体多为IgM，所有抗体滴度均为≤1:2。3组受者术后生存率差异均无统计学意义（均为P > 0.05）。
      结论  小儿血型不合活体肝移植是一种安全有效的治疗方式，可有效扩大肝移植供者来源，挽救患儿生命。

     

    Abstract:
      Objective  To explore the clinical efficacy of pediatric blood type incompatible living donor liver transplantation.
      Methods  The clinical data from 242 cases of pediatric living donor liver transplantation recipients were retrospectively analyzed. Recipients were assigned to group A (ABO-identical group, n=165), group B (ABO-compatible group, n=42) and group C (ABO-incompatible group, n=35) according to the blood type compatibility between the recipients and the donors. The occurrence of postoperative complications and development of postoperative donor specific antibody (DSA) among the 3 groups were observed and compared. And the blood type distribution of donors and recipients and development of erythrocyte antibodies in group C were analyzed. The survival situation of recipients after liver transplantation was compared among the 3 groups.
      Results  There was no significant difference in the incidence of complications among the 3 groups(all P > 0.05). DSA was dominated by human leukocyte antigen (HLA) Ⅱ antibodies after liver transplantation, mostly anti-HLA-DR and anti-HLA-DQ. The postoperative erythrocyte antibodies for liver transplant recipients in group C were dominated by IgM, with titers ≤1:2 for all. The differences in postoperative survival rates were not statistically significant among 3 groups(all P > 0.05).
      Conclusions  Pediatric blood type incompatible living donor liver transplantation is a safe and effective treatment, which can effectively expand the source of liver transplant donors and save the children's lives.

     

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