SUCCESSFUL USE OF AN ENHANCED IMMUNOSUPPRESSIVE PROTOCOL WITH PLASMAPHERESIS FOR ABO-INCOMPATIBLE MISMATCHED GRAFTS IN LIVER-TRANSPLANT RECIPIENTS
SUCCESSFUL USE OF AN ENHANCED IMMUNOSUPPRESSIVE PROTOCOL WITH PLASMAPHERESIS FOR ABO-INCOMPATIBLE MISMATCHED GRAFTS IN LIVER-TRANSPLANT RECIPIENTS
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DOI：
10.1097/00007890-199504150-00011
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发表时间：
1995-04-15
期刊：
影响因子：
6.2
通讯作者：
MILLER, CM
中科院分区：
文献类型：
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作者：
MOR, E;SKERRETT, D;MILLER, CM
ABO 血型不相容的同种异体肝移植后移植物和患者的存活率一直很低。我们使用血浆置换术和有效的免疫抑制方案来控制血凝素水平并预防早期排斥反应。联合器官共享网络状态为 4 的 10 名患者接受了 ABO 血型不相容的同种异体移植物。四联免疫抑制包括OKT3、Cytoxan、环孢素和类固醇锥度；第一周静脉注射前列腺素E-1。所有患者均接受围手术期血浆置换以维持血凝素水平O)，移植后5、12和30天因严重排斥反应而失去移植物。所有 3 名患者的移植前血凝素水平均大于或等于 1:100。血凝素水平升高先于严重急性细胞排斥的诊断；血浆置换未能降低这 3 名患者的抗 A 滴度。我们的结论是，在紧急情况下，通过血浆置换结合四重诱导免疫抑制来降低预先形成的血凝素，可以使肝移植跨越 ABO 障碍。对于预先形成的血凝素基线水平较高的患者，随后移植物丢失的风险可能会增加，并且 ABO 血型不相容的移植物移植可以作为挽救生命的中间步骤。
Graft and patient survival rates after transplantation of ABO-incompatible liver allografts have been poor. We used plasmapheresis and a potent immunosuppressive regimen to control hemagglutinin levels and prevent early rejection. Ten patients who had a United Network for Organ Sharing status of 4 received ABO-incompatible allografts. Quadruple immunosuppression consisted of OKT3, Cytoxan, cyclosporine, and steroid taper; prostaglandin E-1 was administrated intravenously the first week. All patients underwent perioperative plasmapheresis to maintain hemagglutinin levels O) lost their grafts to severe rejection at 5, 12, and 30 days after transplantation. All 3 had pretransplantation hemagglutinin levels greater than or equal to 1:100. Elevated hemagglutinin levels preceded the diagnosis of severe acute cellular rejection; plasmapheresis failed to lower anti-A titers in these 3 patients. We conclude that in an urgent setting, lowering of preformed hemagglutinins via plasmapheresis in combination with quadruple induction immunosuppression allows liver transplantation across ABO barriers. In patients with high baseline levels of preformed hemagglutinins, the risk of subsequent graft loss may be increased and transplantation with an ABO-incompatible graft may serve as a lifesaving intermediate step.