肝移植术后移植物抗宿主病六例临床分析

Clinical analysis of 6 cases of graft-versus-host disease after liver transplantation

目的探讨肝移植术后移植物抗宿主病的治疗方案。方法回顾性分析1997年3月至2017年12月第四军医大学附属西京医院肝胆外科器官移植中心6例诊断为肝移植术后移植物抗宿主病病人的临床资料。均采取减半或停止免疫抑制剂,同时使用大量皮质醇激素联合免疫球蛋白的治疗方法,并积极预防感染和对症支持治疗。结果 1例未见好转,最终死于肺部感染、多脏器功能衰竭;5例病人治疗后体温降至正常,皮疹逐渐消退,白细胞逐渐恢复正常,其中1例在治疗43d后因消化道大量出血死亡,其余4例痊愈出院。结论肝移植后移植物抗宿主病预后极差,提倡早期诊断和早期治疗。使用皮质醇激素冲击治疗联合免疫球蛋白,同时减半至暂时停止常规免疫抑制剂,此方法有效。

Objective To investigate the treatment of graft versus host disease（GVHD）after liver transplantation.Methods The medical records of 6 patients with GVHD after liver transplantation from the Institute of Organ Transplantation of Hepatobiliary Surgery Department of Xijing Hospital Affiliated to the Fourth Military Medical University were analyzed retrospectively.All treatment regimens contained high-dose glucocorticoidand immunoglobulin with half-dose or without immunosuppressive agents.Antibiotic therapy and supportive and symptomatic therapy were also employed.Results One case had no improvement,and eventually died of pulmonary infection and multiple organ failure.After treatment,the body temperature declined to the normal level,the rash gradually faded away,and white blood cells gradually returned to normal in 5 patients.One case died of severe gastrointestinal hemorrhage 43 days after treatment,and the rest 4 cases recovered well and discharged from the hospital.Conclusions The prognosis of GVHD is very poor,and early diagnosis and treatment are very significant.It is effective to employ corticosteroid shock therapy combined with immunoglobulin,and half-dose or temporarily free of the routine immunosuppressants.