肝移植术后患者自行停药致急性排斥反应(附3例报告)

Analysis of acute rejection caused by immunosuppressants self-withdrawal after liver transplantation in three cases

目的探讨肝移植术后患者自行停药致急性排斥反应(AR)的临床特点及治疗。方法回顾性分析2004年1月至2013年6月上海交通大学医学院附属瑞金医院肝移植中心收治肝移植术后因自行停药导致AR的3例患者的临床资料。结果 3例患者均因自行停止服用免疫抑制剂出现肝功能异常而入院治疗,停药18～42 d,经肝穿刺组织病理学结果明确均为急性细胞性排斥反应。给予恢复使用免疫抑制剂的同时采用肾上腺皮质激素(激素)冲击治疗或兔抗人胸腺细胞免疫球蛋白治疗后改小剂量激素维持。2例患者经治疗后好转,另1例经抢救后无效死亡。结论肝移植术后自行停药易发生AR,后果严重,应加强对患者的宣传教育,提高其服药依从性。一旦发生AR,即给予恢复使用免疫抑制剂,同时采用激素冲击或抗体治疗。

Objective To investigate the clinical features and treatment in patients with acute rejection （AR） caused by immunosuppressants self-withdrawal （IS） after liver transplantation （LT）. Methods Clinical data of 3 cases with AR due to IS after LT from January 2004 to June 2013 in Liver Transplantation Center of Ruijin Hospital Affiliated to Medical College of Shanghai Jiaotong University were analyzed retrospectively. Results Three patients were hospitalized for abnormal liver function after IS. The time of IS was 18- 42 d. And acute cellular rejection was confirmed by liver biopsy histopathology. Immunosuppressants were reused and small dose of hormone was used after therapy of adrenocortical hormone shock or rabbit anti-human thymocyte immunoglobulin. Two patients recovered after treatment, and 1 patient died after invalid rescue. Conclusions IS after liver transplantation is prone to AR, usually resulting in serious consequences. Publicity and education of patients should be strengthened to improve their compliance of taking medicine. Once AR occurs, immunosuppressive drugs should be reused immediately with hormone shock or antibody therapy simultaneously.