5例儿童肝移植术后淋巴组织增生性疾病治疗经验和药学监护

Treatment Experience and Pharmaceutical Care of Post-transplant Lymphoproliferative Diseases in 5 Children After Liver Transplantation

目的探讨移植后淋巴组织增生性疾病(PTLD)早期病变在儿童肝移植受者中的药物治疗策略和药学监护要点。方法回顾性分析首都医科大学附属北京友谊医院2015—2019年5例亲体肝移植术后EB病毒相关PTLD儿童的药物治疗过程,分析药学监护要点。结果确诊PTLD后予患儿减停免疫抑制剂并给予利妥昔单抗治疗。对5例患儿的最新随访时间为治疗后17~24个月,患儿移植肝功能平稳,PTLD均有所缓解,EB病毒载量均为阴性。结论PTLD是肝移植术后的严重并发症,其治疗方案尚无统一共识。减停免疫抑制剂并应用利妥昔单抗,可有效治疗儿童EB病毒相关PTLD。加强药学监护可以保证患儿用药的安全性和有效性。

Objective To explore the medical treatment strategy and pharmaceutical care of early lesions of posttransplant lymphoproliferative disease(PTLD)after pediatric liver transplantation.Methods The drug treatment process of 5 children with Epstein Barr virus(EBV)related PTLD after liver transplantation in Beijing Friendship Hospital Affiliated to the Capital Medical University from 2015 to 2019 was analyzed retrospectively,and the key points of pharmaceutical care were also analyzed.Results After the diagnosis of PTLD,the children were reduced the dose or stopped the use of immunosuppressant,and were treated with one or two cycles of rituximab.The latest follow-up time of 5 children was 17-24 months after treatment.Currently,the transplanted liver function was stable,and PTLD was relieved,and EBV viral load remained negative persistently.Conclusion PTLD is a serious complication after liver transplantation.There was no unified consensus on the treatment of PTLD.Reducing or stopping immunosuppressive agents and using rituximab can achieve a satisfactory efficacy for EBV-related PTLD patients after pediatric liver transplantation.Strengthening pharmaceutical care can ensure the safety and effectiveness of medication for children.