New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (Rituximab) and plasma exchange
New strategy for ABO-incompatible living donor liver transplantation with anti-CD20 antibody (Rituximab) and plasma exchange
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DOI：
10.1016/j.transproceed.2004.12.114
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发表时间：
2005-03-01
影响因子：
0.9
通讯作者：
Satomi, S
中科院分区：
文献类型：
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作者：
Kawagishi, N;Satoh, K;Satomi, S
在跨越ABO血型屏障的活体供肝移植(LDLT)中，控制体液排斥反应比匹配或相合的组合更难。我们用新的免疫抑制方案和血浆置换(PE)在ABO血型不合的移植中取得了良好的效果。在82例LDLT中，有10例ABO血型不合的受者，其中3例接受了利妥昔单抗抢救或预防治疗。移植前根据需要进行PE以维持血凝素滴度低于1：16，当移植后出现与高滴度相关的超急性排斥征象时进行PE。诱导免疫抑制包括FK506、类固醇、霉酚酸酯(MM17)和利妥昔单抗。第一例患者在术后第7天(POD)接受利妥昔单抗联合脱氧精氨酸(DSG)、类固醇冲击治疗和PE治疗，因为活检证实为体液急性排斥反应。效价和LFT显著提高。第二组和第三组患者在手术后立即给予美罗华和其他常规免疫抑制剂预防超急性排斥反应。第二例患者表现为LFTs轻微恶化，滴度升高，在类固醇脉冲治疗和PE后恢复正常。第三位患者没有发生排斥反应。目前，分别为术后27个月、17个月和6个月，3例移植受者情况稳定。
It is more difficult to control humoral rejection in living donor liver transplantations (LDLT) across the ABO blood group barrier than in matched or compatible combinations. We achieved excellent results in ABO-incompatible transplantation with novel immunosuppressive regimens and plasma exchange (PE). Among 82 LDLT were 10 cases of ABO-incompatible recipients, including three who were administered rituximab for rescue or prophylactic therapy. Pretransplantation PE was performed as necessary to maintain hemagglutinin titers below 1:16 and posttransplantation PE was performed when there were signs of hyperacute rejection associated with high titers. Induction immunosuppression consisted of FK506, steroid, mycophenolate mofetil (MM17), and rituximab. The first patient was administered rituximab with deoxyspergualin (DSG), steroid pulse therapy, and PE on postoperative day (POD) 7, because of biopsy-proven humoral acute rejection. The titers and LFTs improved drastically. The second and third patients were administered rituximab just after the operation with other routine immunosuppressants for prophylaxis of hyperacute rejection. The second patient showed a slight deterioration in LFTs with an elevated titer, which normalized after steroid pulse therapy and PE. The third patient had no episodes of rejection. At present, that is 27, 17, and 6 months after the operations respectively, the 3 transplant recipients are in stable condition.