摘要
目的探讨急诊状况下ABO血型不合肝移植的疗效及其预后影响因素。方法410例原位肝移植中有8例为ABO血型不合的急诊肝移植,其中受体血型O型5例、非O型3例。术后以四联免疫抑制剂抗排斥反应,观察受体急性排斥反应、血管、胆道并发症、感染和肝肾功能情况。结果患者半年存活率为50%,围手术期死亡率为50%。受体血型O型和非O型、MELD (model for end-stage liver disease)评分＜30分和≥30分、CTP(Child-Turcotte-Pugh)评分＜13分和≥13分、重型肝炎和非重型肝炎、脾切除和非脾切除患者的半年存活率分别为80%和0%、50%和33%、75%和25%、25%和75%、33%和60%。术后并发症有：急性排斥反应1例；胆漏1例；肝叶坏死和肝脓肿2例；肾功能衰竭2例；感染6例(2例为曲霉菌感染)。结论ABO血型不合肝移植预后不佳,围手术期死亡率高,因此仅适用于无法及时获得合适供肝的急诊肝移植。
Objective To evaluate emergent ABO-incompatible liver transplantation. Methods From April 1993 to April 2005, 8 patients including 5 with O type and 3with non-O type received emergent orthotopic liver transplantation（EOLT） with ABO-incompatible grafts among 410 OLT cases, All 8 patients were treated with quadruple immunosuppression therapy including Tacrolimus （FKS06）, mycophenolate mofetil （MMF）, methylprednisolone and IL-2R antibody （Daclizumab or Basilixmab ） perioperatively, Acute rejection, vascular thromboses, biliary tract complication, infection status, and liver and kidney function were monitored. Results The 6-month patient survival rate was 50%, The mortality in perioperative period was 50% due to haemorrhage, infection, and multiorgan failure. The patient survival rates at 6 months with O blood group and non-O blood group, MELD （ Model for End-Stage Liver Disease） score 〈30 and ≥30, CTP （Child-Turcotte-Pugh） score 〈 13 and ≥13, severe hepatitis B and non-severe hepatitis B, splenectomy and non-splenectomy were 80% and 0%, 50% and 33%, 75% and 25%, 25% and 75%, 33% and 60%, respectively. Postoperative complications included acute rejection occurred in one recipient successfully treated by methylprednisolone, bile leakage in 1, liver necrosis and abscess in 2, renal failure in 2, and bacteria or/and fungus infection in 6. Conclusions The prognosis of patients receiving ABO incompatible liver graft is poor, hence it is only applicable in the setting of emergency.
出处
《中华普通外科杂志》
CSCD
北大核心
2006年第6期399-402,共4页
Chinese Journal of General Surgery
基金
国家"九七三"重点基础研究发展规划基金(2003CB5155001)
卫生部省部共建基金(WKJ2005-2-044-01
关键词
肝移植
血型不合
ABO血型系统
Liver transplantation
Blood group incompatibility
ABO blood -group system
