跨血型肝移植26例经验

摘要

Objective To summarize the experiences of 26 case of liver transplantation across ABO barrier in our hospital,and on the basis of literature review,further discuss the feasibility of ABO-incompatible liver transplantation.Methods The clinical data of 395 caces of liver transplantation since January 2009 to December 2012 were retrospectively analyzed.Of them,26 cases were across ABO blood group,including 17 ABO-compatible (ABO-C) and 9 ABO-incompatible (ABO-I).The patients were grouped as ABO-identical(ABO-Id,n =369),ABO-compatible(ABO-C,n =17) and ABO-incompatible(ABO-I,n =9),patient survivals and the rates of biliary complications,vascular complications,infection,acute and chronic rejection were compared among 3 groups.Results the 1-year and 2-year patient's survival rates were 87.3％,82.4％,88.9％,and 78.3％,70.6％,66.7％ in ABO-Id,ABO-C,ABO-I group,respectively.The accumulative survival rates among 3 groups were not significantly different (log rank test,P ＞ 0.05).The incidence of general complications and biliary complications was higher in ABO-I than in ABO-Id(P =0.035,P =0.001).There were no significant differences among the 3 groups in vascular complications,infection,acute and chronic rejection (P ＞ 0.05).Conclusions Although the complication incidence is higher in ABO-incompatible liver transplantation,the patient survival rate is compatible to ABO-compatible liver transplantation.Thus,for patients who are waiting grafts for a long time or need emergent liver transplant,ABO-incompatible liver transplantation is safe and feasible.%目的 总结本中心26例跨血型肝移植经验,在复习文献的基础上,探讨血型不相容肝移植的可行性.方法 回顾性分析本中心2009年1月至2011年12月395例肝移植患者病历资料,其中跨血型肝移植26例(血型相容17例,血型不相容9例).根据供受体血型匹配情况分为3组:血型相符(ABO-Id)组369例、血型相容(ABO-C)组17例和血型不相容(ABO-I)组9例.分析比较各组术后生存率以及胆道并发症、血管并发症、急性排斥反应、慢性排斥反应和感染发生率的差异.结果 3组患者术后1、2年生存率分别为87.3％、82.4％、88.9％和78.3％、70.6％、66.7％,3组术后累计生存率无明显差异(P＞0.05).ABO-I组总体并发症和胆道并发症发生率高于ABO-Id组(P =0.035,P =0.001),血管并发症、急性排斥反应、慢性排斥反应和感染发生率在3组之间的差异无统计学意义(P＞0.05).结论 虽然血型不相容患者肝移植术后并发症发生率高,但生存率逐渐接近血型相符肝移植.因此,对于长期等候供体以及需要急诊肝移植的患者而言,血型不相容肝移植是安全可行的.