| Objective: Analyze the clinical effect of the application of our center in the perioperative treatment of blood group incompatible liver transplantation.analyze the safety and feasibility of the different anti blood group antibody receptor who received blood group incompatible liver transplantation.This plan can increase the source of the donor liver and alleviate the shortage of organs. Methods: Retrospective analyze 256 patients with liver transplantation that was done by the same group in Beijing Friendship Hospital affiliated to Capital Medical University from June,2013 to October 2015,including 17 cases of incompatible liver transplantation, 239 cases of compatible liver transplantation.patients were divided into 17 cases of blood group incompatible group(ABO-i) and 239 cases of blood group compatible group(ABO-c) according to the matching of donor blood type.ABO incompatible liver transplantation group accept our center’s plan that is cross the obstacle of blood group in peri operation period.We devide 17 ABO-i liver transplantation patience into two groups according to anti blood group antibody titer,including high antibody group(IgM or IgG≥1:64,7cases) and low antibody group(IgM orIgG≥1:64,10cases),both of two groups accept our center’s plan that is cross the obstacle of blood group. Then we analyze and find the difference of survival rate, infection, acute rejection, vascular and biliary complications.Collect data: age, gender, diagnosis; surgery length, intraoperative blood loss, cold ischemia time; anti-blood group antibody titer, follow-up, survival time of death, cause of death, postoperative cumulative survival rate, incidence of infection, The incidence of biliary complications, vascular complications incidence of acute rejection rate. Continuous variables with a mean and standard deviation described, between T test and X2 test to compare group differences in survival curves between groups Comparison lok-Rank test. Results: 1.There was no significant difference in the basic data between ABO-i group and ABO-c group before liver transplantation.2. ABO-i group and ABO-c group infectious complications: ABO-i group had lung infection in 6 cases(35.2%, 6/17), EB virus infection in 4 cases(23.52%, 4/17), cytomegalovirus infection in 3 cases(17.64%, 3/17); ABO- group C, 60 cases of pulmonary infection(25.1%, 60/239), cytomegalovirus alone in 7 cases(2.9%, 7/239), EB simplex virus infection in 6 cases(2.5%, 6/239) infection, cytomegalovirus + EB virus infection in 4 cases(1.6%, 4/239), cytomegalovirus + lung infection 13 cases(5.4%, 13/239), EB virus infection in 35 cases of lung +(14.64%, 35/239), giant + cell + EB virus lung infection in 8 cases(3.3%, 8/239), the two groups were not statistically different.3. ABO-i group and ABO-c group of vascular complications: ABO-i group of vascular complications in 4 cases(23.5%, 4/17), portal vein thrombosis in 2 cases(11.76%, 2/17), portal vein stenosis(5.88%, 1/17).ABO-c group of vascular complications in 29 patients(12.13%, 29/239), in which the portal vein 5 cases(2.09% 5/239), portal venous anastomotic stenosis in 9 cases(3.7%, 9/239) thrombosis, transplant hepatic artery thrombosis 15 cases(5.02%, 12/239). There was no significant difference data.4. ABO-i group and B-c group biliary complications : ABO-i set the total number of biliary complications occurred in 2 cases, 1 case of simple biliary anastomotic stricture occurred anastomotic stenosis, biliary sludge formation, intrahepatic bile duct dilatation(line PTCD); ABO-c group biliary / anastomotic stenosis in 7 cases(2.9%, 7/239) bile leakage in 4 cases(1.6%, 4/239), biliary sludge formation in 7 cases(2.9%, 7/239), intrahepatic bile duct dilatation(already line PTCD) 10 patients(4.1%, 10/239), no significant difference between the two groups.5.There was no significant difference in incidence of acute rejection between ABO-i group and ABO-c group.6.The cumulative survival rate of.ABO-i group and ABO-c group was 82.35% and 91.88%.we don’t find any significant difference.7.The average of antibody of titer in ABO-i group is 1:15.6(1:0-1:64),average of IgG is 1:46.9(1:2-1:128).We continuous detective the anti blood group antibodies,and we find in significantly decreased in the early stage after transplantation, the average value dropped to 1:7.4 IgG, 1:21.5 IgM in the first day. Lower antibody titers were sustained for up to 3 weeks.8.There was no significant difference in vascular complications(including portal vein thrombosis, portal vein anastomosis stenosis, hepatic artery thrombosis), infection complications,(including pulmonary infection, EB virus, cytomegalovirus infection,data)and biliary complications(bile duct / biliary intestinal anastomosis stenosis)between high antibody of blood group and low antibody of blood group.No acute rejection occurred in both of this two groups.9.There was no significant difference in the survival rate between the high blood group antibody group and the low anti blood group antibody group in June, which is 82.5% and 90%. Conclusions: It is safe and effective to use the plan with rituximab or IVIG in ABO-i liver transplantation.Compared with the plasma exchange, the portal vein and the hepatic artery infusion therapy,it have better maneuverability and flexibility.In view of the patients with high blood group antibody before surgery,under the premise of non application of plasma exchange,we can receive a good curative effect by using this plan.In the case of shortage of donor liver and no suitable blood type for liver.It provides an effective way to expand the source of the donor liver. |
