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首页> 外文期刊>Therapeutic apheresis and dialysis: official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy >Successful long-term outcome of ABO-incompatible liver transplantation using antigen-specific immunoadsorption columns.
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Successful long-term outcome of ABO-incompatible liver transplantation using antigen-specific immunoadsorption columns.

机译：使用抗原特异性免疫吸附柱成功进行ABO不相容肝移植的长期成功结果。

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ABO-incompatible (ABO-I) liver transplantation has been performed essentially in patients with acute liver failure awaiting an urgent liver transplantation. Early results with ABO-I liver transplantation were disappointing with a very low graft survival rate (20-50%). The main risk is the occurrence of severe humoral and cellular rejection, vascular thrombosis, and biliary complications. In order to avoid humoral rejection and improve graft survival, total plasma exchange in combination with an intense immunosuppressive regimen has been proposed to decrease hemagglutinin titers in ABO-I liver grafts. In some centers, this regimen was associated with splenectomy, phototherapy, and portal or arterial intrahepatic infusion therapy; however, as these patients are at high risk of sepsis, a selective approach using antigen-specific immunoadsorption with immunoadsorbent columns has been successfully proposed for ABO-I living donor kidney transplantation. Few cases have been reported following liver transplantation. We report our recent experience with three adult patients (two patients with acute liver failure, and one with severe cirrhosis and hepatic encephalopathy) transplanted in an emergency situation with an ABO-I liver graft and managed with the use of GlycoSorb ABO immunoadsorbent columns and a quadruple immunosuppressive regimen with preservation of the spleen. Eight sessions were performed in the three patients. Antigen-specific immunoadsorption greatly lowered the anti-A hemagglutinin titers. None of the three patients developed acute humoral or cellular rejection. Two patients are alive at 1.5 and 3 years follow-up with a normally functioning graft. The third patient died with a functioning graft, one month after the transplantation, from septic complications.
机译：已经在等待紧急肝移植的急性肝衰竭患者中进行了ABO不相容（ABO-I）肝移植。 ABO-I肝移植的早期结果令人失望，移植物存活率非常低（20-50％）。主要风险是严重的体液和细胞排斥反应，血管血栓形成和胆道并发症的发生。为了避免体液排斥并改善移植物存活，已经提出总血浆交换结合强烈的免疫抑制方案以降低ABO-1肝移植物中的血凝素滴度。在某些中心，该方案与脾切除术，光疗以及门静脉或动脉肝内输注治疗相关;然而，由于这些患者有败血症的高风险，因此已经成功地提出了使用抗原特异性免疫吸附和免疫吸附柱的选择性方法，用于ABO-1活体供体肾脏移植。肝移植后报道的病例很少。我们报告了我们的近期经验，其中有3例成人患者（2例急性肝衰竭，1例严重肝硬化和肝性脑病）在紧急情况下移植了ABO-I肝移植，并使用GlycoSorb ABO免疫吸附柱和保留脾脏的四联免疫抑制方案。在三名患者中进行了八次治疗。抗原特异性免疫吸附大大降低了抗A血凝素的效价。三名患者均未出现急性体液或细胞排斥反应。两名患者在1.5和3年的随访中还活着，并且移植功能正常。第三名患者在移植后一个月死于败血症并发症，死于功能正常的移植物。

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