Meta analysis of therapeutic effects on patients with ABO-incompatibility liver transplantation
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摘要:
目的 系统评价ABO血型不合肝移植(ILT)的治疗效果，并与ABO血型相合肝移植(CLT)的疗效进行比较。 方法 通过计算机检索PubMed数据库、Embase数据库、Cochrane数据库、Medline数据库、Web of science数据库、中国知网、万方数据库、维普数据库等国内外数据库，收集国内外关于ILT及CLT临床疗效对比的文献，对文献质量进行评估。采用RevMan5.3软件，利用固定效应模型及随机效应模型进行Meta分析。 结果 共纳入18篇文献。Meta分析结果表明ILT组与CLT组受者术后1、3、5年存活率差异无统计学意义(均为P＞0.05)；与CLT组相比，ILT组移植物1、3、5年存活率明显降低，差异有统计学意义(均为P＜0.05)；ILT组术后胆道并发症和急性排斥反应发生率明显高于CLT组，差异有统计学意义(均为P＜0.05)。 结论 与CLT相比，ILT疗效稍逊，但仍可作为受体病情危急情况下或等待供肝时间过长时的新选择。 Abstract:Objective To systematic evaluation the therapeutic effects on patients with ABO-incompatibility liver transplantation (ILT), and compare the curative effect with ABO-compatible liver transplantation (CLT). Methods The literatures of comparison in clinical efficacy between ILT and CLT were collected at home and abroad by computer search in PubMed database, Embase database, Cochrane database, Medline database, Web of science database, CNKI, Wanfang database, VIP database, et al, and the quality of literatures were accessed. Meta analysis was carried out by fixed effect model and random effect model with RevMan5.3 software. Results A total of 18 papers were included. The results of Meta analysis showed that there was no significant difference in the survival rates of recipient between ILT group and CLT group at 1, 3 and 5 years after operation (all P > 0.05). Compared with CLT group, the survival rates of grafts were significantly decreased in ILT group at 1, 3 and 5 years after operation, and the difference was statistically significant (all P < 0.05). The incidences of postoperative biliary complication and acute rejection in ILT group were significantly higher than those in CLT group, the difference was statistically significant (both P < 0.05). Conclusions Compared with CLT, the curative effect of ILT is weaker but still can be used as a new choice for critical condition of the recipient or waiting for the donor liver for a long time. -
Key words:
- Liver transplantation /
- ABO-incompatibility /
- Meta analysis /
- Survival rate /
- Rejection reaction /
- Biliary complication
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图 1 ILT组与CLT组受体1、3、5年存活率的森林图
注：A、B、C图分别为1、3、5年两组受体存活率；Events为存活患者例数
Figure 1. Forest plots of survival rate of recipient at 1, 3, 5 years after operation between ILT group and CLT group
图 2 ILT组与CLT组移植物1、3、5年存活率的森林图
注：A、B、C图分别为1、3、5年两组移植物存活率；Events为存活移植物数量
Figure 2. Forest plots of survival rate of graft at 1, 3, 5 years after operation between ILT group and CLT group
图 3 ILT组与CLT组胆道并发症与排斥反应发生率的森林图
注：A图为胆道并发症发生率，Events为发生胆道并发症例数；B图为排斥反应发生率，Events为发生排斥反应例数
Figure 3. Forest plots of the incidence of biliary complication and rejection at 1, 3, 5 years after operation between ILT group and CLT group
表 1 纳入18篇文献的基本情况
Table 1. Characteristics of 18 included studies
研究作者 年份 国家
或地区ILT组 CLT组 患者年龄段 供体来源 总例数 移植物数 总例数 移植物数 Gugenheim J, et al[1] 1990 法国 17 — 217 — 成人及儿童 非活体 Reding R, et al[2] 1992 比利时 16 16 54 54 成人及儿童 非活体 Bjoro K, et al[3] 2003 北欧 10 10 219 219 成人 非活体 Song GW, et al[6] 2014 韩国 142 142 939 960 儿童 活体 Sanchez-Urdazpal L, et al[7] 1993 美国 — 18 — 18 成人及儿童 非活体 Cacciarelli TV, et al[8] 1995 美国 14 14 130 130 儿童 — Varela-Fascinetto G, et al[9] 1999 美国 28 — 72 — 儿童 — Egawa H, et al[10] 2004 日本 66 16 461 — 成人及儿童 活体 Heffron T, et al[11] 2006 美国 16 16 121 122 儿童 活体 Ueda M, et al[12] 2006 日本 74 74 494 494 儿童 活体 杨扬，等[13] 2007 中国 21 — 45 — 成人 非活体 Toso C, et al[14] 2007 加拿大 14 14 94 94 成人 非活体 Stewart ZA, et al[15] 2009 美国 — 831 — 2 493 成人及儿童 非活体 沈中阳，等[16] 2014 中国 22 — 41 — 成人 非活体 Shen T, et al[17] 2014 中国 35 35 66 66 成人 非活体 Thorsen T, et al[18] 2015 挪威、瑞典 61 61 1 372 1 372 成人 非活体 Lee CF, et al[19] 2015 中国台湾 46 46 340 340 成人 活体 Iwamoto H, et al[20] 2008 日本 15 — 37 — 成人 活体 注：“—”代表研究中未具体提及或难以提取 
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