肝移植后慢性排异反应1例

Chronic rejection following liver transplantation in one case

背景:慢性排异反应进展缓慢,往往呈隐匿性,移植肝功能逐渐减退或丧失。这种损伤是不可逆的,目前尚无有效的治疗办法。目的:分析1例肝移植后慢性排异反应病例,以早期作出正确诊断。方法:分析1例肝移植后3次入院诊断治疗的经过。B超显示:①肝实质回声增高,粗,不均匀。②胆囊切除术后。③脾大。④腹水。腹部CT显示:①肝移植术后。②脾大。住院期间积极给予护肝、支持、对症治疗,丙氨酸转氨酶、天门冬氨酸转氨酶无下降,总胆红素持续不降并有上升,反复腹腔感染。排除其他肝损害原因,经肝组织病理证实为肝移植术后慢性排异反应。结果与结论:病例提示肝移植后不明原因肝脏损害,慢性排异反应应引起重视并应作为鉴别诊断之一,且肝组织病理检测将有助于诊断。对于肝移植后慢性排异反应除外其他肝损害病因并及时进行肝组织病理检测将有助于诊断。

BACKGROUND：Chronic rejection develops slowly with concealed occurrence,presented with nonreversible liver function subsidence or loss,which can not be treated effectively. OBJECTIVE：To analyze a liver transplant recipient with chronic rejection in order to provide reference accurate diagnosis at an early time. METHODS：The process of three-time admission of a liver transplant recipient with chronic rejection was analyzed. Type-B ultrasonic showed：①Echo of liver parenchyma was heightened,thickened,and inequable. ②After cholecystectomy. ③Splenomegaly. ④Abdominal dropsy. Abdominal CT showed：①After liver transplantation. ②Splenomegaly. Liver-protecting,support and symptomatic therapy were performed in duration of hospital stay,but the alanine transaminase and aspartic transaminase levels did not decreased,total bilirubin level increase,with repetitive abdominal infections. Depleting other liver damage reasons,the recipient was confirmed suffering from chronic rejection. RESULTS AND CONCLUSION：Chronic rejection-induced liver damage should be aroused attention and diagnosed when the recipient suffering unexplained damages. Histopathologic examination contributes to the diagnosis of chronic rejection after depleting other liver damage reasons.