肝移植术后重症移植物抗宿主病的救治

Rescue Treatment for Intensive Graft Versus Host Drsease after Liver Transplantation

目的探讨肝移植术后重症移植物抗宿主病(graft versus host disease,GVHD)的救治。方法患者肝移植术后出现高热、全身皮疹及水样便,外周血中性粒细胞缺乏,结合骨髓"噬血现象",诊断重症GVHD。患者立即停服免疫抑制剂,给予大剂量甲基强的松龙冲击治疗,静脉点滴小剂量广谱抗生素,粒细胞集落刺激因子皮下注射,补充丙种球蛋白预防感染;静脉注射洛赛克抑酸,输注血小板以预防消化道出血;严格隔离,胃肠外营养支持。结果患者体温降至正常,皮疹消褪,口腔黏膜糜烂灶愈合,腹泻停止,白细胞和血小板计数逐渐恢复,肝功能稳定。结论治疗肝移植术后重症GVHD患者,可停用常规免疫抑制剂,静脉使用甲基强的松龙冲击治疗。同时应提高自身免疫力,积极预防感染和出血,加强支持治疗。

Objective To investigate the rescue treatment modalities for intensive graft versus host disease （GVHD） following liver transplantation. Methods The diagnosis of GVHD was based on a liver transplanted patient with manifestations of fever, skin rash, watery diarrhea, pancytopenia and hemophagocytosis in bone marrow postoperatively, of Immunosuppressants include Tacrolimus and MMF were prompt withdrawed, and Methylprednisolone （MP） was given intravenously in a adapted pulse dose. Declined dosage of broad antibiotics combined with additional immune global protein and GM-CSF were administered simultaneously. Acid inhibitor Losec and platelet transfusion were used for gastrointestinal bleeding prophylaxis and the patient was isolated strictly with total parenteral nutrition support. Results The patient responded well and survived with body temperature declined, skin rash disappeared, mouth mucosal ulcers revealed, diarrhea remission and cunts of WBC and PLT improved gradually with well-preserved liver graft function during the strategy. Conclusion Immunosuppressants withdrawal, pulse administration of MP, enhancement of host immune function, effective prophylaxis of extensive infection and fatal hemorrhage combined with proper supportive treatment concomitantly may improve the prognosis of intensive GVHD following liver transplantation.