肝移植术后移植物抗宿主病的诊治

Clinical Study of Postoperative Liver Transplant-Associated Graft Versus Host Disease

目的总结肝移植术后移植物抗宿主病的诊断及治疗经验。方法分析总结3例原位肝移植患者治疗急性移植物抗宿主病的临床经过及实验室检查结果，临床表现、皮肤活检及骨髓穿刺结果作为诊断依据，确诊后停止使用免疫抑制剂。结果例1术后12d出现溶血性贫血，术后3～5周出现不明原因发热、皮疹、全血细胞减少，其间肝功能接近正常，患者最后痊愈出院。例2术后出现腹泻、全血细胞减少、消化道出血，于术后25d死亡，死亡原因为感染、消化道出血。例3术后出现发热、慢性腹泻、皮疹和全血细胞减少，最终死于感染、多器官功能衰竭。结论不明原因发热、皮疹和胃肠道症状应警惕移植物抗宿主病发生。停止使用免疫抑制剂，提高机体免疫力可能为更好的治疗方法。

Objective To summarize the clinical experience in the diagnosis and treatment of graft-versus-host disease（GVHD）after liver transplantation. Methods The clinical course and laboratory examination were analyzed in 3 patients with acute GVHD after orthotopic liver transplantation （OLT）. The diagnosis was made according to clinical manifestations, skin or bone-marrow biopsy. Immunosuppressive drugs were withdrawn once it was confirmed that patient had caught GVHD. Results Twelve days after transplantation,patient 1 developed hemolytic anemia. Within 3 to 5 weeks, patient 1 developed unidentified fever, tetter and pancytopenia, but the liver function was normal in all the time. Patient 1 recovered at last. Patient 2 caught diarrhea, pancytopenia and gastrointestinal hemorrhage after liver transplantation and finally died from infection and gastrointestinal hemorrhage in 25 days. Patient 3 caught unidentifed fever, tetter, chronic diarrhea and pancytopenia, and finally died from infection and multiorgan failture. Conclusion For patients of liver transplantation,more attentions should be paid to unidentified high fever, tetter and gastrointestinal syndromes. Withdrawing immunosuppression agent and improving immunity of patients would be the better treatment.