Diagnosis and Treatment for Acute Graft Versus Host Disease after Liver Transplantation (Report of 2 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

李志偉 , 李超 , 馬繼韜 , 張睿 , 董權 , 梁愛君 , 王胤佳 , 周志剛

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Keywords：

肝移植; 移植物抗宿主疾病

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目的　探討肝移植術后早期并發急性移植物抗宿主疾病(GVHD)的診斷和治療。

方法　回顧性分析我院2006年5月至2007年10月期間行肝移植手術50例，其中2例術后并發GVHD，分析該2例肝移植術后第14 d和第18 d以出現不明原因發熱、皮疹、口腔多發潰瘍、全血細胞減少、皮膚病理活檢等臨床資料為診斷依據和以不同的免疫抑制劑治療的方案。

結果　第1例患者加強免疫抑制劑治療，發生敗血癥于術后67 d死于多器官功能衰竭；第2例減少免疫抑制劑治療，術后96 d治愈。

結論　肝移植術后并發GVHD，減少免疫抑制劑方案可能是一種有效方案，但應警惕急性排斥反應和繼發感染發生。

Citation： 李志偉,李超,馬繼韜,張睿,董權,梁愛君,王胤佳,周志剛. Diagnosis and Treatment for Acute Graft Versus Host Disease after Liver Transplantation (Report of 2 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(9): 671-672. doi: Copy

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5.	Pollack MS, Speeg KV, Callander NS, et al. Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis [Ｊ]. Hum Immunol, 2005; 66(1)∶28.
6.	Meves A, el-Azhary RA, Talwalkar JA, et al. Acute graft-versus-host disease after liver transplantation diagnosed by fluorescent in situ hybridization testing of skin biopsy specimens [Ｊ]. J Am Acad Dermatol, 2006; 55(4)∶642.
7.	Wang B, Lu Y, Yu L, et al. Diagnosis and treatment for graft-versus-host disease after liver transplantation: two case reports [Ｊ]. Transplant Proc, 2007; 39(5)∶1696.
8.	高鵬驥，王東，朱繼業，等. 肝移植術后移植物抗宿主病1例 [Ｊ]. 中華普通外科雜志， 2007； 22（4）∶308.
9.	Chinnakotla S, Smith DM, Domiati-Saad R, et al. Acute graft-versus-host disease after liver transplantation: role of withdrawal of immunosuppression in therapeutic management [Ｊ]. Liver Transpl, 2007; 13(1)∶157.
10.	周彥明，楊甲梅. 肝移植術后腹瀉的相關病因及處理 [Ｊ]. 中國普外基礎與臨床雜志， 2007； 14(2)∶155.

1. 　Smith DM, Agura E, Netto G, et al. Liver transplant-associated graft-versus-host disease [Ｊ]. Transplantation, 2003; 75(1)∶118.
2. 　Taylor AL, Gibbs P, Bradley JA. Acute graft versus host disease following liver transplantation: the enemy within [Ｊ]. Am J Transplant, 2004; 4(4)∶466.
3. 　Bettens F, Tiercy JM, Campanile N, et al. Microchimerism after liver transplantation: absence of rejection without abrogation of anti-donor cytotoxic T-lymphocyte-mediated alloreactivity [Ｊ]. Liver Transpl, 2005; 11(3)∶290.
4. 　Schppi MG, Belli DC, Rimensberger PC, et al. Fatal GvHD as a complication of liver transplantation for undetermined fulminant hepatic failure and associated aplastic anemia [Ｊ]. Liver Transpl, 2006; 12(11)∶1693.
5. 　Pollack MS, Speeg KV, Callander NS, et al. Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis [Ｊ]. Hum Immunol, 2005; 66(1)∶28.
6. 　Meves A, el-Azhary RA, Talwalkar JA, et al. Acute graft-versus-host disease after liver transplantation diagnosed by fluorescent in situ hybridization testing of skin biopsy specimens [Ｊ]. J Am Acad Dermatol, 2006; 55(4)∶642.
7. 　Wang B, Lu Y, Yu L, et al. Diagnosis and treatment for graft-versus-host disease after liver transplantation: two case reports [Ｊ]. Transplant Proc, 2007; 39(5)∶1696.
8. 　高鵬驥，王東，朱繼業，等. 肝移植術后移植物抗宿主病1例 [Ｊ]. 中華普通外科雜志， 2007； 22（4）∶308.
9. 　Chinnakotla S, Smith DM, Domiati-Saad R, et al. Acute graft-versus-host disease after liver transplantation: role of withdrawal of immunosuppression in therapeutic management [Ｊ]. Liver Transpl, 2007; 13(1)∶157.
10. 　周彥明，楊甲梅. 肝移植術后腹瀉的相關病因及處理 [Ｊ]. 中國普外基礎與臨床雜志， 2007； 14(2)∶155.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment for Acute Graft Versus Host Disease after Liver Transplantation (Report of 2 Cases)

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