背景:肝移植是对支持治疗难以治疗的严重急性肝衰竭的明确治疗方法,和终末期慢性肝衰竭。由于已故肝脏捐献者的短缺,南非需要创新技术来扩大捐助池。
目的:本研究评估了Wits移植单位ABO不相容肝移植(ABOi-LT)计划的结果。
方法:本回顾性记录回顾比较了从2014年1月至2021年12月接受ABO相容(ABOc)和ABO不相容(ABOi)肝移植的所有成人和儿科患者,至少随访一年。主要结果是受体和移植物存活,次要结果包括血管,肠和胆道并发症,回顾手术,急性细胞排斥反应(ACR)和住院时间。进行Cox比例风险回归以检查ABO相容性组对受体和移植物存活的影响。通过二项回归评估ABO相容性组和分类结果之间的关系。
结果:在研究期间,进行了532例肝移植;44/532(8%)为ABOi,其中14/44(32%)为儿科接受者,30/44(68%)为成人接受者。在儿科组中,与ABOc组(33/207;16%)相比,ABOi组(7/14;50%)接受急性肝衰竭移植的比例明显更高(p=0.005).注意到可比的接受者和移植物存活率估计:一个-,ABOi组患者3年和5年生存率为77%(95%置信区间(CI)44-92),58%(95%CI17-84)和58%(95%CI17-84)。与ABOc组相比,ABOi组手术的相对风险显著增加,总体(相对风险(RR)1.74;95%CI1.10-2.75)和90天(RR2.28;95%CI1.27-4.11);以及用于出院前血流感染(BSI),(RR1.84;95%CI1.11-3.06)。在成年人中,与ABOc组(26/281;9%)相比,ABOi组(10/30;33%)的肝移植急性适应症明显更多(p=0.0007),最常见的原因是药物或毒素摄入(16/36;44%).对于ABOi集团,1年、3年和5年的受体生存率估计值(95%CI)为71%(50-84),63%(41-78)和58%(37-75),如并发症发生率所示,ABO组之间相似。
结论:这项研究证实,ABOi-LT是在这种器官耗尽环境中增加肝脏供体库的可行选择,因为ABO相容性组之间的受体生存率和并发症发生率相似。
BACKGROUND: Liver transplantation is the definitive management for severe acute liver failure refractory to supportive management, and end- stage chronic liver failure. Owing to a shortage of deceased liver donors, South Africa requires innovative techniques to broaden the donor pool.
OBJECTIVE: This study evaluated the outcomes of the Wits Transplant Unit ABO-incompatible liver transplant (ABOi-LT) programme.
METHODS: This retrospective record review compared all adult and paediatric patients receiving ABO-compatible (ABOc) and ABO-incompatible (ABOi) liver transplants from January 2014 to December 2021 with a minimum one-year follow-up. Primary outcomes were recipient and graft survival and secondary outcomes included vascular, enteric and biliary complications, relook surgery, acute cellular rejection (ACR) and lenghth of hospital stay. Cox proportional hazards regression was performed to examine the effect of ABO-compatibility group on recipient and graft survival. The relationship between the ABO-compatibility group and categorical outcomes was assessed by binomial regression.
RESULTS: During the study period, 532 liver transplants were performed; 44/532 (8%) were ABOi of which 14/44 (32%) were paediatric and 30/44 (68%) adult recipients. Within the pediatric group, the proportion of transplants performed for acute liver failure was significantly higher in the ABOi group (7/14; 50%) compared with the ABOc group (33/207; 16%) (p=0.005). Comparable recipient and graft survival estimates were noted: one-, three- and five-year recipient survival in the ABOi group was 77% (95% confidence interval (CI) 44 - 92), 58% (95% CI 17 - 84) and 58% (95% CI 17 - 84) respectively. There were significantly increased relative risks of relook surgery for the ABOi group compared with the ABOc group, both overall (relative risk (RR) 1.74; 95% CI 1.10 - 2.75) and at 90 days (RR 2.28; 95% CI 1.27 - 4.11); and also, for pre-discharge bloodstream infection (BSI), (RR 1.84; 95% CI 1.11 - 3.06). In adults, there were significantly more acute indications for liver transplantation in the ABOi (10/30; 33%) compared with the ABOc group (26/281; 9%) (p=0.0007) with the most common cause being drug or toxin ingestion (16/36; 44%). For the ABOi group, recipient survival estimates (95% CI) at 1, 3 and 5 years were 71% (50 - 84), 63% (41 - 78) and 58% (37 - 75) which, as noted with complication rates, were similar between ABO groups.
CONCLUSIONS: This study confirms ABOi-LT as a feasible option to increase the liver donor pool in this organ-depleted setting as recipient survival and complication rates were similar between ABO-compatibility groups.