肝移植受者急性移植物抗宿主病的治疗

Treatment of Acute Graft-versus-host Disease after Liver Transplantation

目的初步探讨肝移植受者急性移植物抗宿主病(acute graft-versus-host disease,aGVHD)的救治。方法 3例肝癌患者肝移植术后早期出现高热、皮疹及水泻,外周血白细胞及血小板计数进行性下降,结合骨髓和皮肤活检,诊断为aGVHD。立即停止常规免疫抑制治疗,给予甲基强的松龙(methyprednisolone,MP)冲击,补充大剂量静脉注射用人免疫球蛋白(intravenous immunoglobulin,IVIG)。粒巨细胞集落刺激因子皮下注射,使用抑酸剂,甄别使用抗生素。成分输血,加强支持治疗和基础护理。结果全部患者体温降至正常,皮疹逐渐消褪。其中2例患者腹泻停止,白细胞和血小板计数逐渐恢复,痊愈出院。1例患者出现继发性再生障碍性贫血,死于败血症。结论治疗肝移植术后aGVHD,应早期停用常规免疫抑制剂,及时使用MP冲击,补充大剂量IVIG,促进患者自身免疫力的恢复,积极预防感染和出血,加强支持治疗。

Objective To investigate the treatment of acute graft-versus-host disease （aGVHD） in liver recipients. Methods Three patients who presented with high fever, skin rash, and watery diarrhea and had decreased peripheral white blood cell count and platelet count at early time after liver transplantation were diagnosed with aGVHD based on the results of bone marrow and skin biopsy examinations. Oral immunosuppressants were promptly discontinued, methyiprednisolone （MP） was pulse-administered intravenously and high-dose intravenous immunoglobulin （IVIG） was given. Moreover, GM-CSF was subcutaneously injected,and acid inhibitors and antibiotics were tailored to the patients. Blood transfusion, enhanced nutrition support and basic nursing were given as well. Results The temperature of all the patients dropped to the normal level. The skin rash gradually disappeared. Two patients recovered from diarrhea and were discharged from hospital with normal white blood cell and platelet counts. One patient developed secondary aplastic anemia and died of sepsis. Conclusion Treatments of aGVHD after liver transplantation consist of withdrawal of routine immunosuppressants at early time, high-dose IVIG and immediate MP pulse administrations, enhancement of host immune function, effective prophylaxis of infections and hemorrhage and proper supportive treatment.