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首页> 美国卫生研究院文献>Journal of Korean Medical Science >Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer Model for End-Stage Liver Disease Score and Graft Liver Volume
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Preoperative Selective Desensitization of Live Donor Liver Transplant Recipients Considering the Degree of T Lymphocyte Cross-Match Titer Model for End-Stage Liver Disease Score and Graft Liver Volume

机译：考虑T淋巴细胞交叉配比滴度终末期肝病评分模型和肝移植量的活体供肝移植受者的术前选择性脱敏

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摘要

Several studies have suggested that a positive lymphocyte cross-matching (XM) is associated with low graft survival rates and a high prevalence of acute rejection after adult living donor liver transplantations (ALDLTs) using a small-for-size graft. However, there is still no consensus on preoperative desensitization. We adopted the desensitization protocol from ABO-incompatible LDLT. We performed desensitization for the selected patients according to the degree of T lymphocyte cross-match titer, model for end-stage liver disease (MELD) score, and graft liver volume. We retrospectively evaluated 230 consecutive ALDLT recipients for 5 yr. Eleven recipients (4.8%) showed a positive XM. Among them, five patients with the high titer (> 1:16) by antihuman globulin-augmented method (T-AHG) and one with a low titer but a high MELD score of 36 were selected for desensitization: rituximab injection and plasmapheresis before the transplantation. There were no major side effects of desensitization. Four of the patients showed successful depletion of the T-AHG titer. There was no mortality and hyperacute rejection in lymphocyte XM-positive patients, showing no significant difference in survival outcome between two groups (P=1.000). In conclusion, this desensitization protocol for the selected recipients considering the degree of T lymphocyte cross-match titer, MELD score, and graft liver volume is feasible and safe.Graphical Abstract
机译：多项研究表明，阳性淋巴细胞交叉匹配（XM）与较低的移植物存活率和使用小尺寸移植物的成人活体供体肝移植（ALDLT）后急性排斥反应的高发生率相关。但是，关于术前脱敏尚无共识。我们采用了与ABO不兼容的LDLT的脱敏协议。我们根据T淋巴细胞交叉匹配滴度的程度，终末期肝病（MELD）评分模型和移植肝体积对所选患者进行了脱敏。我们回顾性评估了230名连续5年的ALDLT接受者。 11位接受者（4.8％）的XM阳性。其中，选择5例通过抗人球蛋白增强方法（T-AHG）高滴度（> 1:16）的患者和1滴度低但MELD得分高的患者36进行脱敏：利妥昔单抗注射和血浆置换移植。脱敏没有主要的副作用。其中四名患者显示T-AHG滴度成功耗尽。淋巴细胞XM阳性患者没有死亡率和超急性排斥反应，两组之间的生存结果无显着差异（P = 1.000）。总之，考虑到T淋巴细胞交叉匹配效价的程度，MELD评分和移植肝体积，针对所选受体的脱敏方案是可行和安全的。

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