Abstract：
In cases of acute liver failure (ALF) with hepatic coma, early liver transplantation, including ABO-incompatible (ABOi) living donor liver transplantation (LDLT), should be considered. The ABO antibody barrier can be reduced using plasma exchange (PE) and the anti-CD20 antibody rituximab. Plasma exchange is also performed for drug-induced ALF and is effective for desensitization. Rituximab treatment usually requires 14 days. There is presently no established desensitization protocol for ABOi-LDLT for ALF. Here, we report a case of drug-induced ALF with hepatic coma, which was treated with ABOi-LDLT using PE and rituximab 8 days prior to surgery. A 33-year-old female, with a history of headaches for which she was taking analgesics daily, developed drug-induced ALF with hepatic coma. Her ABOi sister desired to become a liver donor. We initiated desensitization using rituximab (500 mg) and mycophenolate mofetil (MMF, 2000 mg/day), followed by five sessions of PE. Eight days after rituximab administration, ABOi-LDLT with splenectomy was performed. Postoperatively, the patient received local infusion via portal vein for 14 days and immunosuppression with tacrolimus, methylprednisolone, and MMF. No episode of cellular or antibody-mediated rejection (AMR) was observed. The patient was discharged uneventfully 56 days after ABOi-LDLT with no problems up to 15 months after the transplant.
摘要：
在急性肝功能衰竭（ALF）伴肝昏迷的情况下，早期肝移植,包括ABO血型不合（ABOi）活体肝移植（LDLT），应该考虑。可以使用血浆置换(PE)和抗CD20抗体利妥昔单抗来降低ABO抗体屏障。还对药物诱导的ALF进行血浆置换,并且对脱敏有效。利妥昔单抗治疗通常需要14天。目前还没有建立用于ALF的ABOi-LDLT的脱敏方案。这里,我们报告一例药物性ALF伴肝昏迷,在手术前8天使用PE和利妥昔单抗进行ABOi-LDLT治疗。一位33岁的女性,她有头痛史，每天都在服用镇痛药，发展药物诱导的ALF与肝昏迷。她的ABOi姐姐希望成为肝脏捐赠者。我们使用利妥昔单抗（500毫克）和霉酚酸酯（MMF，2000毫克/天)，其次是五次体育课。利妥昔单抗给药后八天,行ABOi-LDLT合并脾切除术。术后,患者通过门静脉局部输注14天，并使用他克莫司进行免疫抑制，甲基强的松龙,和MMF。没有观察到细胞或抗体介导的排斥(AMR)的发作。患者在ABOi-LDLT后56天顺利出院，在移植后15个月内没有任何问题。
