| Objective:At present,donor liver mainly comes from donation after cardiac death(DCD)in China.Because the timing of organ acquisition is uncertain,most liver transplants belong to emergency surgery,especially for ABO incompatibility liver transplantation.Since preoperative preparation time is short,many preoperative intervention measures are difficult to implement smoothly.Therefore,we need to develop a simple,safe and effective preoperative intervention program in a short period of time to solve the problem of crossing the ABO barrier.Herein,the aim of this study was to develop a simplified,safe,and effective preoperative intervention protocol to solve this problem.We applied a novel immune-induction protocol based on ATG-F in patients with ABO incompatibility with liver transplantation,the efficacy and safety of this immune-inducing regimen were explored.Methods:A retrospective analysis was performed on 75 patients who underwent liver transplantation at the Organ Transplantation Center,Sichuan Provincial People's Hospital between January 2016 and January 2018.All patients were divided into ABO-i group and ABO-c group,immune-related indicators such as antibody titer and lymphocyte subsets,postoperative complications such as rejection,and postoperative complications such as infection,vascular and biliary complications,and the differences in transplant recipient and graft survival rates were compared between the two groups.Results:A total of 75 liver transplant patients were enrolled in this study,and15 patients in the ABO-i group and 60 patients in the ABO-c group.Compared on the basis of the patient's baseline index,the two groups were found no statistically significant in gender,age,MELD score,Child-Pugh grading,operative time,cold ischemia time,anhepatic phase time,hepatic arterial anastomosis time,intraoperative blood loss,ICU stay,and total length of hospital stay.In addition,there was no statistically significant difference in postoperative liver function and coagulation function between the two groups.Investigating the postoperative immune parameters revealed that the ratio of CD3~+,CD3CD4~+,and CD3CD8~+T lymphocytes in peripheral blood in the ABO-I group was significantly lower than that in ABO-c group(P<0.05)in 1,3,5 and 7d after operation,and it was lowest in 1-7d after operation,and then gradually increased.The proportions of CD3~+,CD3CD4~+,and CD3CD8~+T lymphocytes in peripheral blood of both groups were significantly lower than those before operation(P<0.05).In addition,we also found that the antibody titer decreased quickly after liver transplantation in the ABO-i group,and the mean value on 1d after operation decreased by 1:8(1:1 to 1:32),but it was inceresed during 1w and 1m after operation.We also found that the ratio of CD3CD4~+T lymphocytes was positively correlated with antibody titer at 2w after operation in the ABO-i group(r=0.976).We found no statistically significant in postoperative infections,vascular and biliary complications,acute rejection,hepatorenal syndrome,postoperative diabetes,postoperative tumor recurrence and metastasis,and graft complications between the two groups.In addition,the 1-year survival rates of liver transplantation patients in the ABO-i and ABO-c group were 80.0%and 88.3%,respectively.The ABO-i group had 3deaths(including 2 died of infection and 1 died of liver failure).The 1-year survival rate of transplant graft in the ABO-i and ABO-c groups was 80.0%and87.3%,respectively.The ABO-c group had 2 secondary transplantations,and ABO-i group had no secondary transplantations.There was no significant difference in the 1-year survival rate of transplant patients and graft between the two groups.Conclusions:The novel immune-inducing protocol based on ATG-F is safe and effective in ABO-incompatible liver transplantation.It not only significantly inhibits postoperative lymphocyte subsets.However,it does not increase the risk of complications after liver transplantation,but also ensures that ABO-i liver transplantation achieves ABO-c liver transplantation similar to transplant patients and graft survival. |
PDF Full Text Request