ABO-incompatible liver transplantation for children under 2?years of age: A case report and a single-center review
ABO-incompatible liver transplantation for children under 2?years of age: A case report and a single-center review
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2岁以下儿童ABO血型不合肝移植一例报告及单中心评价
DOI：
10.1111/petr.13308
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发表时间：
2018
影响因子：
1.3
通讯作者：
Kasahara Mureo
中科院分区：
文献类型：
--
作者：
Narumoto Soichi;Sakamoto Seisuke;Sasaki Kengo;Hirata Yoshihiro;Fukuda Akinari;Uchiyama Toru;Irie Rie;Yoshioka Takako;Kasahara Mureo
RTX脱敏已被广泛引入成人LT跨越ABO血型屏障。对于儿科LT，RTX的预防性使用尚未标准化，特别是对于2岁以下的儿童。一名20个月大的BA女孩接受了其ABO‐I母亲的活体供者LT。术后第6天，她发生了T细胞介导的AMR和AMR。立即进行类固醇推注，随后进行PE和IVIG的抗体耗竭治疗。基于通过荧光激活细胞分选术进行的外周血淋巴细胞分析，针对难治性排斥反应引入了ATG和RTX。虽然她从合并拒绝中恢复过来，但IHBCs是不可避免的。我们建议将脱敏方案扩展到2岁以下的儿童，以防止危及生命的并发症。
Desensitization with RTX has been broadly introduced in adult LT across the ABO blood type barrier. For pediatric LT, the prophylactic use of RTX has not been standardized, especially for children under 2 years of age. A 20‐month‐old girl with BA underwent living donor LT from her ABO‐I mother. On POD 6, she developed combined T cell‐mediated and AMRs. Steroid bolus injection was immediately introduced, followed by antibody‐depleting therapy with PE and IVIG. Based on a peripheral blood lymphocyte analysis by fluorescence‐activated cell sorting, ATG and RTX were introduced for refractory rejection. Although she recovered from the combined rejections, IHBCs were inevitable as a consequence. We recommend extending the desensitization protocol to cover children under 2 years of age in order to prevent life‐threatening complications.