【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。更多还原

【Abstract】 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 (FK506), 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 methyiprednisolone, 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.更多还原