Yuan Yuanhong,Zhang Hui,Xiao Zhenghui,et al.Therapeutic effect of plasma exchange on antibody mediated rejection after living relative donor liver transplantation in children[J].Journal of Clinical Pediatric Surgery,,21():425-430.[doi:10.3760/cma.j.cn101785-202202012-006]
Therapeutic effect of plasma exchange on antibody mediated rejection after living relative donor liver transplantation in children
- Keywords:
- Liver Transplantation/MT; Living Donors/CL; Plasma Exchange; Graft Rejection; Immuno- suppression; Treatment Outcome; Child
- Abstract:
- Objective To explore the clinical efficacy of plasma exchange (PE) for antibody mediated rejection (AMR) after living relative donor liver transplantation. Methods Clinical data were retrospectively reviewed for a 7-month-old child with biliary atresia and biliary cirrhosis after living relative donor liver trans- plantation. Tacrolimus plus prednisone was prescribed for anti-rejection therapy after compatible blood type living relative donor liver transplantation. Liver function abnormality was caused predominantly by a postopera- tive elevation of bilirubin within 1 month. Then transplanted liver was biopsied and antibody test of human leu- kocyte antigen (HLA) performed. Results Liver biopsy revealed acute rejection reaction. Based upon the positive result of HLA II antibody and C4d, it could be confirmed as donor specific antibody (DSA) -induced AMR. The regimen was composed of intravenous methylprednisolone pulse, immunoglobulin, mycophenolate and immunosuppressive agents. However, the effect was not satisfactory. And then PE was performed every 2 days for a total of 5 sessions. After 1 -month treatment, liver function gradually normalized. Follow-up was conducted for 3 years. Transplanted liver was biopsied for 5 times and rejection gradually lessened and liver function basically stablized. There was no recrudescence of AMR. Conclusion Postoperative AMR occurs in children with com- patible blood type living relative donor liver transplantation. Early treatment plus PE may be more beneficial to the recovery of acute AMR after liver transplantation.
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Memo
收稿日期:2022-2-7。
基金项目:国家十二五科技支撑项目（2012BAI04B01）；湖南省科技创新重点工程项目（2020SK10141-3）；湖南省科技厅重点实验室项目（2018TP1028）；湖南省卫生健康委课题项目（C2019019）
通讯作者:肖政辉,Email:xzh2010@163.com