肝移植术后并发严重骨髓抑制(附6例报告)

Severe bone marrow suppression after liver transplantation:a report of 6 cases

目的总结肝移植术后严重骨髓抑制并发症的临床特点，探讨其发生原因及预防措施。方法回顾性分析2002—2006年天津市第一中心医院收治的肝移植术后并发严重骨髓抑制6例病人的临床资料。结果所有病例均因终末期肝病进行肝脏移植，术后应用标准的免疫抑制剂方案：FK506＋骁悉＋激素，术后2周常规静脉用更昔洛韦预防巨细胞病毒感染。严重骨髓抑制（白细胞计数〈1．0×10^9／L）发生于术后19～78d，临床表现包括发热伴有或不伴有皮疹、消化道症状、感染以致发生严重的败血症。5例肝功能在治疗过程中始终是正常的。所有病例均死于严重败血症及多脏器功能衰竭。结论肝移植术后严重骨髓抑制的发生可能与免疫反应、药物毒性及严重感染有关，其发生率及确切的发生机制尚不清楚。肝移植术后严重骨髓抑制一旦发生，预后极差，应根据可能的诱发因素采取积极的预防措施。

Objective To summarize the clinical characters of severe bone marrow suppression after liver transplantation and find effective measures to prevent severe bone mairow suppression occurring. Methods The clinical data of 6 cases of severe bone marrow suppression after liver transplantation occurred between 2002 and 2006 in Tianjin First Central Hospital were analyzed retrospectively. Results All patients received standard immunosuppressive protocols for liver transplantation,including a combination of tacrolimus, mycophenolate mofetil （MMF） and steroid. Ganciclovir was used for prophylaxis cytomegalovirus in each case. Severe bone marrow suppression （ white blood cell count 〈 1.0 ×10^9/L ） occurred from 19 to 78 days after transplantation. Clinical manifestations included fever,nausea ,skin rash, infection even to sepsis. Liver functions of case 1 to 5 were almost normal until to dead. All patients were dead of severe sepsis and multiple system organ failure. Conclusion Severe bone marrow suppression after liver transplantation maybe relates to immune reaction,drug toxicity,severe infection or other reasons. The incidence and accurate pathogenesis are unclear. Once severe bone marrow suppression occurred, the prognosis is very poor. It＇ s important to take effective measures to prevent severe bone mairow suppression occurring.