臨床外科64巻4号

2009年04月発行

特集 脾臓をめぐる最近のトピックス

ABO血液型不適合生体肝移植における脾摘の意義

著者： 田辺稔¹ 河地茂行¹ 尾原秀明¹ 篠田昌宏¹ 日比泰造¹ 下島直樹¹ 渕本康史¹ 星野健¹ 杜雯林² 坂本亨宇² 森川康英¹ 北川雄光¹

所属機関： ¹慶應義塾大学医学部外科 ²慶應義塾大学医学部病理

ページ範囲：P.467 - P.475

要旨：1985年にAlexandreらがABO血液型不適合腎移植における抗体関連拒絶反応を回避するための具体的な方法として，血漿交換による抗体除去と抗体産生の場である脾臓を摘出する方法を提唱して以来，脾摘はABO血液型不適合移植を行ううえで重要な役割を担ってきた．その後，ミコフェノール酸モフェチル（MMF）やリツキシマブなどの新規免疫抑制剤や，術前の脱感作療法，肝移植では局所注入療法の導入により，ABO血液型不適合肝・腎移植の成績は近年さらに向上し，新たな時代を迎えつつある．本稿では血液型不適合移植の歴史を紐解くとともに，ABO血液型不適合の分野で常に肝移植の模範となってきた腎移植と比較しながら，ABO血液型不適合肝移植の動向と，変化しつつある脾摘の意義について触れたい．

参考文献

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