Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation
Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation
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DOI：
10.1097/00007890-200206270-00021
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发表时间：
2002-06-27
期刊：
影响因子：
6.2
通讯作者：
Kitajima, M
中科院分区：
文献类型：
--
作者：
Tanabe, M;Shimazu, M;Kitajima, M
背景ABO血型不合的肝移植术后过程极其复杂，尤其是当受者是成年人时。2例成人患者接受了ABO血型不合供体的活体肝移植。抗排斥治疗包括多次血浆置换术、脾切除术、他克莫司、甲泼尼龙、环磷酰胺或硫唑嘌呤三联免疫抑制方案。除了这些常规方法外，我们还在移植后进行了门静脉内输注甲基强的松龙、前列腺素E和甲磺酸加贝酯的治疗。根据我们的方案，两例患者的抗供体血型抗体滴度均保持较低水平，在整个术后过程中没有任何排斥反应或血管并发症的证据。胆道并发症是短暂的，并完全解决。患者在移植后分别存活了30个月和12个月，并恢复了正常的生活活动，肝功能良好。我们的经验表明，在门静脉内输注治疗下，成人ABO血型不合肝移植的排斥反应和其他并发症的控制是可行的。
Background. ABO-incompatible liver transplantation is associated with an extremely complicated postoperative course, especially when the recipients are adults.Methods. Two adult patients underwent living-donor liver transplantation from ABO-incompatible donors. The antirejection therapy included multiple perioperative plasmapheresis, splenectomy, systemic triple immunosuppressive regimen with tacrolimus, methylprednisolone, and cyclophophamide, or azathioprine. In addition to these conventional approaches, we performed intraportal infusion therapy after transplantation with methylprednisolone, prostaglandin E, and gabexate mesilate.Results. With our protocol, antidonor blood group antibody titers in both cases remained low without any evidence of rejection or vascular complications throughout the postoperative course. Biliary complications were transient and resolved completely. The patients have now survived 30 and 12 months post-transplantation and have regained normal life activity with good liver function.Conclusions. Our experience has shown the feasibility of controlling rejection and other complications in adult ABO-incompatible liver transplantation under intraportal infusion therapy.