儿童ABO血型不合与相合肝移植疗效比较的Meta分析

摘要

目的 应用Meta分析对儿童ABO血型不合肝移植(ILT)与儿童ABO血型相合肝移植(CLT)的疗效进行比较.方法 检索PubMed、Embase、Cochrane library、中国知网、万方、维普等国内外数据库,检索时间截至2017年5月.根据制定的纳入标准和排除标准筛选符合要求的文献,提取数据.采用Review Manager 5.3软件,应用随机效应模型或固定效应模型进行Meta分析.结果 共纳入11篇英文文献,均为回顾性队列研究.Meta分析结果表明ILT组受者术后1年存活率明显低于CLT组[比值比(OR)=0.64,95%可信区间(CI)0.49~0.83,P=0.0007)];ILT组术后排斥反应发生率明显高于CLT组(OR=1.96,95%CI 1.03~3.72,P=0.04);两组的术后3、10年受者存活率,术后1、3、10年移植物存活率,术后胆道并发症发生率差异无统计学意义(均为P>0.05).结论 与CLT比较,ILT受者1年存活率较低而排斥反应发生率较高,但两组受者和移植物长期存活率及胆道并发症发生率相似.表明ILT是在紧急情况下挽救患者生命或长时间无法等到血型相合的肝源时较为理想的选择.%Objective To compare the clinical efficacy between pediatric ABO-incompatible liver transplantation (ILT) and ABO-compatible liver transplantation (CLT) by Meta-analysis. Methods Relevant studies published until May 2017 were electronically retrieved from PubMed, Embase, Cochrane library, China national knowledge internet (CNKI),Wanfang and VIP databases. According to the inclusion and exclusion criteria, the publications eligible were screened and clinical data were extracted. Meta-analysis was performed using the random or fixed effect model analyses with Review Manager 5.3 statistical software. Results Eleven retrospective cohort studies in English were selected. Meta-analysis demonstrated that the postoperative 1-year survival rate of the recipients in the ILT group was significantly lower than that in the CLT group [odds ratio (OR)=0.64, 95% confidence interval (CI) 0.49-0.83, P=0.0007)]. In the ILT group, the incidence of postoperative rejection reactions was considerably higher compared with that in the CLT group (OR=1.96,95% CI 1.03-3.72, P=0.04). No statistical significance was observed in the postoperative 3- and 10-year survival rate of the recipients, 1-, 3- and 10-year survival rate of the graft and the incidence of postoperative biliary tract complications between two groups (all P>0.05). Conclusions Compared with their CLT counterparts, the 1-year survival rate of the ILT recipients is lower, whereas the incidence of rejection reactions is higher. However, the long-term survival rate of both the recipient and graft and the incidence of biliary tract complications do not significantly differ between CLT and ILT. ILT is a relatively ideal option for emergent patients or those lacking of liver graft with compatible blood group for a long period of time.