摘要目的 明确Rh血型错配对肝移植受者安全性的影响.方法 回顾性分析我院自1996年5月至2018年12月1546例肝移植,Rh血型错配5例,针对每例错配肝移植匹配5例Rh血型相同肝移植,分别定义为Rh血型错配组及Rh血型相同组.比较两组受者术后第7、14天血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(SCr)水平,术后1个月、6个月、12个月血清总胆红素、γ-谷氨酰转肽酶(GGT),术后1个月、3个月、6个月血红蛋白水平,术后感染、血管性并发症以及术后6个月内急性排斥反应发生情况;采用间接抗球蛋白试验(indirect antiglobulin test,IAT)检测Rh血型错配肝移植受者术后1个月、6个月、12个月抗Rh(D)抗体产生情况.结果 两组受者术后各时间点血清ALT、AST、肌酐、TB、GGT以及血红蛋白水平水平差异无统计学意义(均P>0.05);两组受者术后感染、血管性并发症以及急性排斥反应发生率均无明显差异(均P>0.05);Rh血型错配组有4例围手术期输注Rh(+)RBC,术后均未发生溶血性贫血,各时间点检测抗Rh(D)抗体均为阴性.结论 因我国Rh阴性血型稀少,在无法匹配到Rh相同供肝或受者的情况下,行Rh血型错配肝移植是安全、可行的.

abstractsObjective To explore the safety of liver transplantation recipients with Rh blood group mismatchming .Methods From May 2005 to December 2018 ,1546 cases of liver transplantation in our hospital were retrospectively analyzed . Among these cases ,5 cases of Rh blood group mismatched were Rh(-) recipients receiving Rh(+ ) donor liver .For each Rh blood group mismatched liver transplantation ,5 patients received the same Rh blood group liver allograft were matched according to a certain principle and were defined as Rh-mismatch group and Rh-match group respectively .The serum alanine aminotransferase (ALT ) ,aspartate aminotransferase (AST ) and creatinine(SCr)were compared between two groups at Days 7 & 14 post-operation .Serum total bilirubin(TB) ,gamma-glutamyl transpeptidase(GGT)were compared between two groups at Month 1 , 6 & 12 post-operation .Hemoglobin (Hb)were compared between two groups Month 1 ,3 & 6 post-operation . The rates of infection ,vascular complications and acute rejection was also compared . Indirect antiglobulin test (IAT)was used for detecting the production of anti-RhD antibody in patients in Rh-mismatch group at Month 1 ,6 & 12 post-operation .Results At the mentioned time ,no significant inter-group difference existed in serum ALT ,AST ,SCr ,TB ,GGT and blood Hb levels (all P>0 .05);Also ,no significant difference existed in the incidence of infection ,vascular complications or acute rejection(all P> 0 .05) .In Rhmismatch group ,4 recipients received Rh (+ )RBC transfusion during perioperative period and no hemolytic anemia occurred after operation .Rh(D) antibody was negative at all timepoints .Conclusions Taking into account the rarity of Rh-negative blood group in Chinese ,it is safe and feasible to carry out Rh blood group mismatched liver transplantation when donor or recipient with the same Rh blood group is not available .