摘要
目的探讨ABO血型不相容肝移植(ABOi-LT)治疗肝癌患者的效果及安全性。方法运用倾向性评分匹配(PSM)方法以1∶2的比例,将44例接受ABOi-LT的肝癌受者与88例ABO血型相容肝移植(ABOc-LT)的肝癌受者进行匹配。比较两组间受者及移植物的存活情况及并发症发生情况。结果ABOi组和ABOc组受者术后第7天血清肌酐水平分别为(89.1±36.9)和(74.8±26.2)μmol/L(P=0.001);术后第14天分别为(77.9±27.6)和(67.6±18.6)μmol/L(P=0.002)。术后肝动脉血栓形成发生率分别为9.1%和1.1%(P=0.024),胆道并发症发生率分别为25.0%和8.0%(P=0.007),移植物早期功能不全发生率分别为52.3%和31.8%(P<0.001),急性肾损伤发生率分别为68.1%和36.4%(P<0.001)。ABOc组受者的术后累积存活率、无瘤存活率和移植物存活率均显著高于ABOi组(P<0.001)。按是否符合杭州标准进行亚组分类后显示,符合杭州标准的两组术后存活率及并发症发生率并无差异,而在不符合杭州标准的ABOi组累积存活率、无瘤存活率及移植物存活率均显著低于ABOc组(P<0.001)。结论ABOi-LT受者术后存活率显著低于ABOc-LT受者。但符合杭州标准的肝癌患者,其ABOi-LT预后与ABOc-LT相近;不符合杭州标准的肝癌患者的ABOi-LT预后显著劣于ABOc-LT,对于此类患者在ABOi-LT前应精准评估、谨慎实施,或通过降期等多种治疗手段使更多患者获得移植机会以及改善预后。
Objective To explore the efficacy and safety of ABO-incompatible(ABO-I)liver transplantation for hepatocellular carcinoma.Methods Forty-four ABO-I liver transplantation recipients were matched with ABO-compatible(ABO-C)recipients by propensity score matching in a ratio of 1:2.The cumulative overall survival(OS)rate,disease-free survival(DFS)rate and complications were compared between two groups.Results Compared with ABO-C group,the levels of serum creatinine(sCr)were significantly higher in ABO-I group at Days 7 and 14 post-operation(89.1±36.9 vs 74.8±26.2 umol/L,P=0.001;77.9±27.6 vs 67.6±18.6 umol/L,P=0.002).The incidence of hepatic arterial thrombosis(9.1%vs 1.1%,P=0.024),biliary complications(25.0%vs 8.0%,P=0.007),early allograft dysfunction(52.3%vs 31.8%,P<0.001)and acute kidney injury(68.1%vs 36.4%,P<0.001)also significantly spiked in ABO-I group.The postoperative cumulative OS,DFS and graft survival rate of ABO-C group were significantly higher than those of ABO-I group(P<0.001).No inter-group difference existed in survival rate or complication incidence in accordance with the Hangzhou criteria.However,OS,DFS and graft survival rates of ABO-I group were significantly lower than those of ABO-C group(P<0.001)and the incidence of hepatic artery thrombosis(6.7%vs 0.0%,P=0.043),biliary complications(30.0%vs 6.7%,P=0.003),early allograft dysfunction(53.3%vs 28.3%,P=0.020)and acute kidney injury(63.3%vs 28.3%,P<0.001)significantly rose exceeding the Hangzhou criteria.Conclusions ABO-I liver transplantation does not affect the OS rate,graft survival rate and postoperative complications in accordance with the Hangzhou criteria.For HCC recipients exceeding the Hangzhou criteria,the prognosis of ABO-I liver transplantation is significantly inferior to that of ABO-C liver transplantation.Careful implementations and accurate evaluations should be performed for ABO-I liver transplantation.Patients exceeding the Hangzhou criteria may receive down-staging treatment so as to obtain transplantation opportunities and yie
作者
卫强
杨梦凡
周之晟
沈恬
郑树森
庄莉
徐骁
Wei Qiang;Yang Mengfan;Zhou Zhisheng;Shen Tian;Zheng Shusen;Zhuang Li;Xu Xiao(Department of Hepatobiliary&Pancreatic Surgery,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Hepatobiliary and Pancreatic Surgery,First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;China Liver Transplant Registry,Hangzhou 310003,China;Department of Hepatobiliary&Pancreatic Surgery,Shulan(Hangzhou)Hospital,Hangzhou 310022,China)
出处
《中华器官移植杂志》
CAS
北大核心
2020年第5期275-280,共6页
Chinese Journal of Organ Transplantation
基金
国家自然科学基金(81930016,81800578,81570589)
国家科技重大专项(2017ZX10203205)。
关键词
肝癌
肝移植
ABO血型不相容
杭州标准
倾向性评分匹配法
Hepatocellular carcinoma
Liver transplantation
ABO-incompatible
Hangzhou criteria
Propensity score matching
