Current status of liver transplantation across ABO blood-type barrier
Current status of liver transplantation across ABO blood-type barrier
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DOI：
10.1007/s00534-007-1298-2
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发表时间：
2008-03-01
期刊：
影响因子：
--
通讯作者：
Ozawa, Kazue
中科院分区：
文献类型：
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作者：
Egawa, Hiroto;Ohdan, Hideki;Ozawa, Kazue
ABO血型不合肝移植的结局最近由于各种治疗而得到改善。抗体介导的排斥反应（antibody mediated rejection，AMR）的典型临床表现是肝坏死和肝内胆道并发症（intrahepatic biliary complications，IHBC）。AMR的预后较差。AMR是循环障碍的结果，循环障碍是由抗体-抗原-补体反应引起的内皮损伤引起的。严重AMR的门静脉毛细血管和门静脉周围区域弥漫性C4d染色。由于针对A/B碳水化合物决定簇的天然抗体可能由于暴露于表达类似决定簇的环境细菌而产生，因此推测B-1谱系是响应A/B决定簇的B细胞类型的主要群体。钙调磷酸酶抑制剂阻断B-1细胞分化。利妥昔单抗可用于消除产生IgM抗体的细胞和已分化为B-1细胞的细胞。需要吗替麦考酚酯来抑制IgG亚类抗体的产生。现在的结果与血型匹配移植相似。然而，仍有一些问题有待解决，以便通过减少感染来进一步改善结果。
Outcomes of ABO-blood type incompatible liver transplantation have recently improved owing to various treatments. The typical clinical manifestations of antibody mediated rejection (AMR) are hepatic necrosis and intrahepatic biliary complication (IHBC). The prognosis of AMR is poor. AMR is the result of circulatory disturbance which is caused by injury to the endothelium due to an antibody-antigen-complement reaction. Diffuse C4d staining in the portal capillaries and periportal areas in severe AMR. Since natural antibodies against A/B carbohydrate determinants are likely to develop as a result of exposure to environmental bacteria that express similar determinants, the B-1 lineage has been speculated to be the major population of B-cell types responding to A/B determinants. Calcineurin inhibitors block B-1 cell differentiation. Rituximab can be used to deplete both cells that are producing IgM antibodies and those that have already differentiated into B-1 cells. Mycophenolate mofetil is required to inhibit the production of IgG subclass of antibodies. The outcome is now similar to that of blood-type-matched transplantation. However, there are still issues to be solved in order to further improve the outcome via a decrease of infection.