OutcomesafterlivertransplantationinaccordancewithABOcompatibility:Asystematicreviewandmeta-analysis

摘要： AIMToevaluatethedifferencesinoutcomesbetweenABOincompatible(ABO-I)livertransplantation(LT)andABO-compatible(ABO-C)LT.METHODSAsystematicreviewandmeta-analysiswereperformedbysearchingeligiblearticlespublishedbeforeNovember28,2016onMEDLINE(PubMed),EMBASE,andCochranedatabases.Theprimaryendpointsweregraftsurvival,patientsurvival,andABO-I-relatedcomplications.RESULTSTwenty-oneretrospectiveobservationalstudieswithatotalof8247patientswereincludedinthismetaanalysis.PooledresultsofpatientsurvivalforABO-ILTwerecomparabletothoseforABO-CLT.However,ABO-ILTshowedapoorergraftsurvivalthanABO-CLT(1-year:OR=0.66,95%CI:0.57-0.76,P<0.001;3-year:OR=0.74,95%CI0.64-0.85,P<0.001;5-yearr:OR=0.75,95%CI:0.66-0.86,P<0.001).Furthermore,ABO-ILTwasassociatedwithmoreincidencesofantibody-mediatedrejection(OR=74.21,95%CI:16.32-337.45,P<0.001),chronicrejection(OR=2.28,95%CI:1.00-5.22,P=0.05),cytomegalovirusinfection(OR=2.64,95%CI:1.63-4.29,P<0.001),overallbiliarycomplication(OR=1.52,95%CI:1.01-2.28,P=0.04),andhepaticarterycomplication(OR=4.17,95%CI:2.26-7.67,P<0.001)thanABO-CLT.Insubgroupanalyses,ABO-ILTandABO-CLTshowedacomparablegraftsurvivalinpediatricpatientsandthoseusingrituximab,andABO-ILTshowedanincreasedacutecellularrejectionincasesinvolvingdeceaseddonorgrafts.CONCLUSIONAlthoughpatientsurvivalinABO-ILTwascomparabletothatinABO-CLT,ABO-ILTwasinferiortoABO-CLTingraftsurvivalandseveralcomplications.GraftsurvivalofABO-ILTcouldbecomparabletothatofABO-CLTinpediatricpatientsandthoseusingrituximab. ... （共18頁）