肝脏移植术后移植物抗宿主病三例报告

Craft versus host disease after liver transplantation:a report of 3 cases

目的 探讨与总结肝脏移植术后移植物抗宿主病 (CVHD)的诊断及治疗经验。方法 跟踪并分析 3例原位肝脏移植患者急性GVHD的临床经过和实验室检查结果。临床表现、皮肤活检、外周血HLA及聚合酶链反应扩增短串联重复序列 (PCR -STR)检查作为其诊断依据。并对免疫抑制剂进行调整。结果 3例在术后 3～ 8周内均出现不明原因的发热、皮疹、腹泻、中性粒细胞减少或全血细胞减少 ,期间肝功能均正常或接近正常 ,巨细胞病毒 (CMV)早期抗原 (pp6 5 )、EB病毒抗体(lgM )均阴性。术后受体外周血淋巴细胞可检测到供体HLA抗原 ,1例女性受体外周血PCR -STR检测到供体Y染色体嵌合。 3例患者最终均死于感染、消化道出血、多器官功能衰竭等并发症。结论 肝移植术后GVHD的发性并非罕见 ,早期易被误诊 ,治疗效果令人失望。

Objective To document the clinical experience in the diagnosis and treatment of graftversus-host disease(GVHD) after liver transplantation.Methods Clinical course was followed up and laboratory examinations were done in 3 patients with orthotopic liver transplantation(OLT)who developed acute GVHD.The diagnosis depended on clinical manifestations,skin biopsy,HLA typing and PCR short tandem repeat(PCR-STR).Immunosuppressive drugs were transferred and adjusted.Results Ferer,skin rash,diarrhea and pancytopenia were found within 3 to 8 weeks after liver transplantation.The liver function was normal.CMV antigen(pp65)and EBV antibody(IgM)were negative.The donor's HLA was detected in the host's peripheral blood cells.One female recipient had the donor's Y chromosome microchimerism detected by PCR-STR.All 3 patients died from infection,alimentary tract bleeding,or multiple organ failure in the end.Conclusion GVHD is not a rare complication easily misdiagnosed with pessimism outcome after liver transplantation.