肝移植术后移植物抗宿主病3例临床诊疗分析

Clinical analysis of 3 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(graft-versus-host-disease,GVHD)的诊治策略。方法连续收集2020年1月—2022年4月就诊于青岛大学附属医院的肝移植术后GVHD患者的临床资料,描述性分析其临床特点及治疗经验。结果共计3例患者肝移植术后发生GVHD,经治疗无效均因严重感染、多器官功能衰竭而死亡。典型临床症状包括发热、皮疹、腹泻及骨髓抑制。皮肤病理活检表现为表皮角化不全、基底层细胞空泡变性及真皮层内见淋巴细胞浸润。T淋巴细胞嵌合率检测提示呈供体T淋巴细胞嵌合状态。治疗策略包括预防感染、停用免疫抑制剂、大剂量糖皮质激素冲击治疗、单克隆抗体治疗及对症支持治疗。结论肝移植术后GVHD预后差,诊断依赖于典型临床症状和辅助检查,以大剂量糖皮质激素冲击治疗为基础构成肝移植术后GVHD的综合治疗策略。

Objective To investigate the diagnosis and treatment of graft-versus-host-disease(GVHD)after liver transplantation.Methods The data of patients with GVHD after liver transplantation in The Affiliated Hospital of Qingdao University from January 2020 to April 2022 were collected,and their clinical characteristics and treatment experience were descriptively analyzed.Results Three patients developed GVHD after liver transplantation,all died due to sepsis and multiple organ failure.Typical clinical symptoms include fever,rash,diarrhea,and myelosuppression.Skin pathological biopsy showed epidermal keratosis,vacuolar degeneration of basal layer cells and lymphocyte infiltration in dermis.Chimerism rate of T lymphocytes showed donor T lymphocyte chimerism.Treatment strategies included infection prevention,withdrawal of immunosuppressive agents,high-dose glucocorticoid bolus therapy,monoclonal antibody therapy and symptomatic support therapy.Conclusion The prognosis of GVHD after liver transplantation is poor.The diagnosis of GVHD after liver transplantation is based on typical clinical symptoms and auxiliary examinations,and the comprehensive treatment strategy is based on high-dose glucocorticoid bolus therapy.