切换至 "中华医学电子期刊资源库"
高级检索
中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (02) : 152 -159. doi: 10.3877/cma.j.issn.2095-3232.2026.02.003

专家论坛

ABO血型不相容肝移植免疫抑制策略
麦吾兰江·麦麦提, 阿力娅·图拉丁, 吐尔洪江·吐逊†()   
  1. 830054　乌鲁木齐，新疆医科大学第一附属医院消化血管外科中心　肝脏·腹腔镜外科
  • 收稿日期:2025-08-08 出版日期:2026-04-10
  • 通信作者: 吐尔洪江·吐逊
  • 基金资助:
    国家自然科学基金(82260411，82270632)

Immunosuppression strategy for ABO-incompatible liver transplantation

·Maimaiti Maiwulanjiang, ·Tulading Aliya, ·Tuxun Tuerhongjiang†()   

  1. Department of Liver and Laparoscopic Surgery, Digestive Vascular Surgery Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
  • Received:2025-08-08 Published:2026-04-10
  • Corresponding author: ·Tuxun Tuerhongjiang
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

麦吾兰江·麦麦提, 阿力娅·图拉丁, 吐尔洪江·吐逊. ABO血型不相容肝移植免疫抑制策略[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 152-159.

·Maimaiti Maiwulanjiang, ·Tulading Aliya, ·Tuxun Tuerhongjiang. Immunosuppression strategy for ABO-incompatible liver transplantation[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(02): 152-159.

近年来，器官移植技术不断进步与发展，国内外各类器官移植技术日趋成熟。自全球首例肝移植手术实施至今，肝移植已成为治疗急性肝衰竭和终末期肝病的重要手段，如今在各大移植中心已常规开展。然而，目前全球面临供肝短缺问题仍严峻，同时亚洲国家慢性乙型病毒性肝炎发病率高，等待肝移植患者数量日益增加，其中多数急危重症肝病患者难以及时匹配血型相合的供肝，因病情恶化而失去最佳手术时机甚至死亡。供体少于受体的供需失衡现状亟待解决，ABO血型不相容肝移植（ABOi-LT）作为扩大肝脏供体来源的有效策略，为等待肝移植患者带来新的希望。但与此同时，ABOi-LT术后易发生肝坏死、肝内胆道并发症、ABO血型抗体介导的排斥反应（AMR）、术后感染、肾损伤等并发症，其中最为严重的是AMR。因此，预防AMR的发生是ABOi-LT成败的关键所在。本文旨在结合国内外相关文献总结ABOi-LT及其免疫抑制策略的最新研究结果，为临床肝移植研究提供参考。

关键词: ABO血型不相容肝移植, 抗体介导的排斥反应, 免疫抑制, 儿童肝移植

With persistent advancement and development of organ transplantation technology in recent years, transplantation technologies for different organs have gradually matured at home and abroad. Since the first case of liver transplantation worldwide, liver transplantation has become an important treatment for acute liver failure and end-stage liver diseases, which has been routinely carried out in major transplantation centers. However, the existing shortage of donor liver is still severe across the globe. Meantime, the incidence of chronic hepatitis B is high in Asian countries, and the number of recipients awaiting liver transplantation is increasing. Most patients with acute and critical liver diseases fail to receive blood type-matched donor liver, lose the operation opportunity or even die because of the disease deterioration. Considering the donor-recipient imbalance caused by fewer donors than recipients, ABO-incompatible liver transplantation (ABOi-LT), as an effective strategy to expand the source of liver donors, brings new hope to the recipients awaiting liver transplantation. However, liver necrosis, intrahepatic biliary complications, ABO blood group antibody-mediated rejection (AMR), postoperative infection, kidney injury are prone to occur after ABOi-LT, among which AMR is the most threatening complication. Therefore, preventing the occurrence of AMR is the key to success of ABOi-LT. In this article, the latest research results of ABOi-LT and immunosuppression strategies were summarized in combination with relevant literature review at home and abroad, aiming to provide reference for the study of clinical liver transplantation.

Key words: ABO-incompatible liver transplantation (ABOi-LT), Antibody-mediate rejection (AMR), Immunosuppression, Pediatric liver transplantation
[1]
Starzl TE, Koep LJ, Halgrimson CG, et al. Fifteen years of clinical liver transplantation[J]. Gastroenterology, 1979, 77(2): 375-388.
[2]
Jadaun SS, Saigal S, Agarwal S, et al. Practice of ABO-incompatible living donor liver transplant in India: an initial experience based on a survey[J]. J Clin Exp Hepatol, 2023, 13(5): 927-929.DOI: 10.1016/j.jceh.2023.04.007.
[3]
Xiao M, Wan Z, Lin X, et al. ABO-incompatible liver transplantation under the desensitization protocol with rituximab: effect on biliary microbiota and metabolites[J]. J Clin Med, 2022, 12(1): 141.DOI: 10.3390/jcm12010141.
[4]
Gordon RD, Iwatsuki S, Esquivel CO, et al. Liver transplantation across ABO blood groups[J]. Surgery, 1986, 100(2): 342-348.
[5]
Gugenheim J, Samuel D, Fabiani B, et al. Rejection of ABO incompatible liver allografts in man[J]. Transplant Proc, 1989, 21(1 Pt 2): 2223-2224.
[6]
Gugenheim J, Samuel D, Reynes M, et al. Liver transplantation across ABO blood group barriers[J]. Lancet, 1990, 336(8714): 519-523.DOI: 10.1016/0140-6736(90)92082-s.
[7]
Reding R, Veyckemans F, de Ville de Goyet J, et al. ABO-incompatible orthotopic liver allografting in urgent indications[J]. Surg Gynecol Obstet, 1992, 174(1): 59-64.
[8]
Egawa H, Oike F, Buhler L, et al. Impact of recipient age on outcome of ABO-incompatible living-donor liver transplantation[J]. Transplantation, 2004, 77(3): 403-411.DOI: 10.1097/01.TP.0000110295.88926.5C.
[9]
Rouger P, Poupon R, Gane P, et al. Expression of blood group antigens including HLA markers in human adult liver[J]. Tissue Antigens, 1986, 27(2): 78-86.DOI: 10.1111/j.1399-0039.1986.tb01502.x.
[10]
Watkins WM. The ABO blood group system: historical background[J]. Transfus Med, 2001, 11(4): 243-265.DOI: 10.1046/j.1365-3148.2001.00321.x.
[11]
Montgomery RA, Cozzi E, West LJ, et al. Humoral immunity and antibody-mediated rejection in solid organ transplantation[J]. Semin Immunol, 2011, 23(4): 224-234.DOI: 10.1016/j.smim.2011.08.021.
[12]
Ikegami T, Taketomi A, Soejima Y, et al. Rituximab, IVIG, and plasma exchange without graft local infusion treatment: a new protocol in ABO incompatible living donor liver transplantation[J]. Transplantation, 2009, 88(3): 303-307.DOI: 10.1097/TP.0b013e3181adcae6.
[13]
Raut V, Uemoto S. Management of ABO-incompatible living-donor liver transplantation: past and present trends[J]. Surg Today, 2011, 41(3): 317-322.DOI: 10.1007/s00595-010-4437-3.
[14]
Egawa H, Teramukai S, Haga H, et al. Present status of ABO-incompatible living donor liver transplantation in Japan[J]. Hepatology, 2008, 47(1): 143-152.DOI: 10.1002/hep.21928.
[15]
Hanto DW, Fecteau AH, Alonso MH, et al. ABO-incompatible liver transplantation with no immunological graft losses using total plasma exchange, splenectomy, and quadruple immunosuppression: evidence for accommodation[J]. Liver Transpl, 2003, 9(1): 22-30.DOI: 10.1053/jlts.2003.50011.
[16]
Song GW, Lee SG, Hwang S, et al. ABO-incompatible adult living donor liver transplantation under the desensitization protocol with rituximab[J]. Am J Transplant, 2016, 16(1): 157-170.DOI: 10.1111/ajt.13444.
[17]
Genberg H, Kumlien G, Wennberg L, et al. The efficacy of antigen-specific immunoadsorption and rebound of anti-A/B antibodies in ABO-incompatible kidney transplantation[J]. Nephrol Dial Transplant, 2011, 26(7): 2394-2400.DOI: 10.1093/ndt/gfr237.
[18]
Lee EC, Kim SH, Shim JR, et al. A comparison of desensitization methods: Rituximab with/without plasmapheresis in ABO-incompatible living donor liver transplantation[J]. Hepatobiliary Pancreat Dis Int, 2018, 17(2): 119-125.DOI: 10.1016/j.hbpd.2018. 2.005.
[19]
Kim JM, Kwon CHD, Joh JW, et al. ABO-incompatible living donor liver transplantation is suitable in patients without ABO-matched donor[J]. J Hepatol, 2013, 59(6): 1215-1222.DOI: 10.1016/j.jhep.2013.07.035.
[20]
Lee J, Kim EJ, Yang SJ, et al. Impact of the baseline anti-a/b igg titer on the clinical outcome in abo-incompatible liver transplantation[J]. Transplantation, 2020, 104(S3): S526.DOI: 10.1097/01.tp.0000701344.29242.43.
[21]
Makroo RN, Agrawal S, Chowdhry M, et al. Efficacy of single, extended and goal directed immunoadsorption in ABO incompatible living related donor liver transplantation[J]. Transfus Apher Sci, 2016, 55(3): 329-332.DOI: 10.1016/j.transci.2016.08.007.
[22]
Agarwal S, Maheshwari A, Bajpai M. Large volume plasmapheresis using a single-use immunoadsorption column: a cost-effective approach for desensitization in ABO-incompatible liver transplant[J]. J Clin Apher, 2023, 38(5): 548-554.DOI: 10.1002/jca.22058.
[23]
Egawa H, Ohmori K, Haga H, et al. B-cell surface marker analysis for improvement of rituximab prophylaxis in ABO-incompatible adult living donor liver transplantation[J]. Liver Transpl, 2007, 13(4): 579-588.DOI: 10.1002/lt.21092.
[24]
Usui M, Isaji S, Mizuno S, et al. Experiences and problems pre-operative anti-CD20 monoclonal antibody infusion therapy with splenectomy and plasma exchange for ABO-incompatible living-donor liver transplantation[J]. Clin Transplant, 2007, 21(1): 24-31.DOI: 10.1111/j.1399-0012.2006.00572.x.
[25]
Sawada T, Fuchinoue S, Teraoka S. Successful A1-to-O ABO-incompatible kidney transplantation after a preconditioning regimen consisting of anti-CD20 monoclonal antibody infusions, splenectomy, and double-filtration plasmapheresis[J]. Transplantation, 2002, 74(9): 1207-1210.DOI: 10.1097/00007890-200211150-00001.
[26]
Monteiro I, McLoughlin LM, Fisher A, et al. Rituximab with plasmapheresis and splenectomy in abo-incompatible liver transplantation[J]. Transplantation, 2003, 76(11): 1648-1649.DOI: 10.1097/01.TP.0000082723.02477.87.
[27]
Sood P, Hariharan S. Anti-CD20 blocker rituximab in kidney transplantation[J]. Transplantation, 2018, 102(1): 44-58.DOI: 10.1097/TP.0000000000001849.
[28]
Hoffman W, Lakkis FG, Chalasani G. B cells, antibodies, and more[J]. Clin J Am Soc Nephrol, 2016, 11(1): 137-154.DOI: 10.2215/CJN.09430915.
[29]
Weiner GJ. Rituximab: mechanism of action[J]. Semin Hematol, 2010, 47(2): 115-123.DOI: 10.1053/j.seminhematol.2010.01.011.
[30]
Usuda M, Fujimori K, Koyamada N, et al. Successful use of anti-CD20 monoclonal antibody (rituximab) for ABO-incompatible living-related liver transplantation[J]. Transplantation, 2005, 79(1): 12-16.DOI: 10.1097/01.tp.0000149337.40911.e4.
[31]
Egawa H, Umeshita K, Uemoto S. Optimal dosage regimen for rituximab in ABO-incompatible living donor liver transplantation[J]. J Hepatobiliary Pancreat Sci, 2017, 24(2): 89-94.DOI: 10.1002/jhbp.419.
[32]
Cvetkovi ć RS, Perry CM. Rituximab: a review of its use in non-Hodgkin's lymphoma and chronic lymphocytic leukaemia[J]. Drugs, 2006, 66(6): 791-820.DOI: 10.2165/00003495-200666060-00005.
[33]
Egawa H, Teramukai S, Haga H, et al. Impact of rituximab desensitization on blood-type-incompatible adult living donor liver transplantation: a Japanese multicenter study[J]. Am J Transplant, 2014, 14(1): 102-114.DOI: 10.1111/ajt.12520.
[34]
Yamamoto H, Uchida K, Kawabata S, et al. Feasibility of monotherapy by rituximab without additional desensitization in ABO-incompatible living-donor liver transplantation[J]. Transplantation, 2018, 102(1): 97-104.DOI: 10.1097/TP.0000000000001956.
[35]
Shimazu M, Kitajima M. Living donor liver transplantation with special reference to ABO-incompatible grafts and small-for-size grafts[J]. World J Surg, 2004, 28(1): 2-7.DOI: 10.1007/s00268-003-7263-6.
[36]
Raut V, Mori A, Kaido T, et al. Splenectomy does not offer immunological benefits in ABO-incompatible liver transplantation with a preoperative rituximab[J]. Transplantation, 2012, 93(1): 99-105.DOI: 10.1097/TP.0b013e318239e8e4.
[37]
Cheng CH, Lee CF, Wang YC, et al. ABO-incompatible liver transplantation: state of art and future perspectives[J]. Curr Pharm Des, 2020, 26(28): 3406-3417.DOI: 10.2174/1381612826666200506094539.
[38]
Jordan SC, Quartel AW, Czer LS, et al. Posttransplant therapy using high-dose human immunoglobulin (intravenous gammaglobulin) to control acute humoral rejection in renal and cardiac allograft recipients and potential mechanism of action[J]. Transplantation, 1998, 66(6): 800-805.DOI: 10.1097/00007890-199809270-00017.
[39]
Kim JD, Choi DL, Kim SG, et al. Single-center experience of ABO-incompatible living-donor liver transplantation with a new simplified intravenous immunoglobulin protocol: a propensity score-matching analysis[J]. Transplant Proc, 2016, 48(4): 1134-1138.DOI: 10.1016/j.transproceed.2016.02.040.
[40]
Lee SD, Kim SH, Kong SY, et al. ABO-incompatible living donor liver transplantation without graft local infusion and splenectomy[J]. HPB, 2014, 16(9): 807-813.DOI: 10.1111/hpb.12215.
[41]
Kim SH, Lee EC, Shim JR, et al. A simplified protocol using rituximab and immunoglobulin for ABO-incompatible low-titre living donor liver transplantation[J]. Liver Int, 2018, 38(5): 932-939.DOI: 10.1111/liv.13614.
[42]
Tanabe M, Shimazu M, Wakabayashi G, et al. Intraportal infusion therapy as a novel approach to adult ABO-incompatible liver transplantation[J]. Transplantation, 2002, 73(12): 1959-1961.DOI: 10.1097/00007890-200206270-00021.
[43]
Tanabe M, Kawachi S, Obara H, et al. Current progress in ABO-incompatible liver transplantation[J]. Eur J Clin Invest, 2010, 40(10): 943-949.DOI: 10.1111/j.1365-2362.2010.02339.x.
[44]
Oh J, Kim JM. Immunologic strategies and outcomes in ABO-incompatible living donor liver transplantation[J]. Clin Mol Hepatol, 2020, 26(1): 1-6.DOI: 10.3350/cmh.2019.0023.
[45]
Visetti M, Leigheb G, Scudeller G, et al. The importance of subgroups A1-A2 and cross reactions A-B for the survival of skin allografts[J]. Minerva Dermatol, 1967, 42(12): 563-569.
[46]
Economidou J, Hughes-Jones NC, Gardner B. Quantitative measurements concerning A and B antigen sites[J]. Vox Sang, 1967, 12(5): 321-328.DOI: 10.1111/j.1423-0410.1967.tb03362.x.
[47]
Rydberg L, Breimer ME, Samuelsson BE, et al. Blood group ABO-incompatible (A2 to O) kidney transplantation in human subjects: a clinical, serologic, and biochemical approach[J]. Transplant Proc, 1987, 19(6): 4528-4537.
[48]
Fishbein TM, Emre S, Guy SR, et al. Safe transplantation of blood type A2 livers to blood type O recipients[J]. Transplantation, 1999, 67(7): 1071-1073.DOI: 10.1097/00007890-199904150-00024.
[49]
Skogsberg U, Breimer ME, Friman S, et al. Successful ABO-incompatible liver transplantation using A2 donors[J]. Transplant Proc, 2006, 38(8): 2667-2670.DOI: 10.1016/j.transproceed.2006.07.025.
[50]
Toso C, Al-Qahtani M, Alsaif FA, et al. ABO-incompatible liver transplantation for critically ill adult patients[J]. Transpl Int, 2007, 20(8): 675-681.DOI: 10.1111/j.1432-2277.2007.00492.x.
[51]
Kluger MD, Guarrera JV, Olsen SK, et al. Safety of blood group A2-to-O liver transplantation: an analysis of the United Network of Organ Sharing database[J]. Transplantation, 2012, 94(5): 526-531.DOI: 10.1097/TP.0b013e31825c591e.
[52]
Stewart ZA, Locke JE, Montgomery RA, et al. ABO-incompatible deceased donor liver transplantation in the United States: a national registry analysis[J]. Liver Transpl, 2009, 15(8): 883-893.DOI: 10.1002/lt.21723.
[53]
Rana A, Kueht ML, Nicholas SK, et al. Pediatric liver transplantation across the ABO blood group barrier: is it an obstacle in the modern era?[J]. J Am Coll Surg, 2016, 222(4): 681-689.DOI: 10.1016/j.jamcollsurg.2015.12.041.
[54]
Mysore KR, Himes RW, Rana A, et al. ABO-incompatible deceased donor pediatric liver transplantation: Novel titer-based management protocol and outcomes[J]. Pediatr Transplant, 2018, 22(7): e13263.DOI: 10.1111/petr.13263.
[1] 那淑芳, 李玲, 罗明, 叶啟发. Castleman病相关肾衰竭与肾移植预后[J/OL]. 中华移植杂志(电子版), 2025, 19(04): 274-279.
[2] 徐菁, 贺田, 沈晓佳, 汪淑敏, 吴林燕, 沈鸣雁, 寿张飞. 肾移植受者免疫抑制剂服药依从性与衰弱和电子健康素养的相关性研究[J/OL]. 中华移植杂志(电子版), 2025, 19(03): 170-174.
[3] 中华医学会器官移植学分会肝移植学组, 中国医师协会器官移植医师分会. 中国自身免疫性肝病肝移植受者免疫抑制方案应用指南[J/OL]. 中华移植杂志(电子版), 2025, 19(02): 76-85.
[4] 中华医学会器官移植学分会肝移植学组, 中国医师协会器官移植医师分会. 中国肝移植受者麦考酚钠临床应用指南(2024 版)[J/OL]. 中华移植杂志(电子版), 2024, 18(06): 366-373.
[5] 中华医学会器官移植学分会肝移植学组, 中国医师协会器官移植医师分会. 中国肝移植受者抗胸腺细胞免疫球蛋白临床应用指南[J/OL]. 中华移植杂志(电子版), 2024, 18(06): 346-354.
[6] 谢开晶, 张迅, 王耀丽. 创伤后脓毒症：不可忽视的严重并发症[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(06): 1048-1052.
[7] 韩晓, 汤凤莲, 张友文, 吕高超, 姜波, 王利江. 结缔组织相关性间质性肺病血清S1P 水平与疾病严重程度和免疫抑制治疗的关系[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(06): 869-874.
[8] 高成立, 何凯明, 冯啸, 曾凯宁, 唐晖, 姚嘉, 杨卿, 易慧敏, 易述红, 杨扬, 傅斌生. 肝移植治疗儿童遗传代谢性肝病安全性及疗效：单中心44例分析[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 844-851.
[9] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[10] 魏志鸿, 刘建勇, 吴小雅, 杨芳, 吕立志, 江艺, 蔡秋程. 肝移植术后急性移植物抗宿主病的诊治（附四例报告）[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 846-851.
[11] 张英信, 林婷, 张剑文. 构建靶向HLA-A2且表达PD-L1的CAR-Treg细胞及验证其对CD4+T细胞抑制作用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 719-728.
[12] 韩培杰, 苏晓乐, 王利华, 裴欢欣. 狼疮性肾炎的治疗进展[J/OL]. 中华肾病研究电子杂志, 2026, 15(01): 46-56.
[13] 苏生林, 马金兰, 于弘明, 杨晓军. 单细胞测序技术在脓毒症免疫研究中的应用进展[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 279-286.
[14] 樊勇, 郝燕捷, 赵娟, 耿研, 张卓莉. 免疫检查点抑制剂治疗既往存在自身免疫性疾病的肿瘤患者：挑战与期待[J/OL]. 中华临床医师杂志(电子版), 2024, 18(12): 1146-1149.
[15] 叶禾清, 李杰, 张玉元, 胡炉淇, 吴白露, 李鑫, 叶书文, 李一帆, 高玥, 詹鹏超, 吕培杰, 李臻. 载药微球化疗栓塞联合多纳非尼及PD-1治疗中晚期大肝癌的疗效分析[J/OL]. 中华介入放射学电子杂志, 2024, 12(03): 212-216.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？