BACKGROUND Graft-versus-host disease(GVHD)following liver transplantation(LT)is an unpredictable complication with poor outcome.However,consensus regarding the diagnosis and therapeutic regimen for the disease is yet ...BACKGROUND Graft-versus-host disease(GVHD)following liver transplantation(LT)is an unpredictable complication with poor outcome.However,consensus regarding the diagnosis and therapeutic regimen for the disease is yet lacking.The present study summarized the clinical experience on the diagnosis and treatment of acute GVHD(aGVHD)following LT and reviewed the pertinent literature.CASE SUMMARY Between January 1^(st),2000 and December 31^(st),2020,a total of 1053 LT were performed in the First Affiliated Hospital of Xi’an Jiaotong University.Six recipients developed aGVHD with clinical symptoms of fever,rash,diarrhea,and pancytopenia.The incidence of aGVHD was 0.57%.The median time from LT to the clinical presentation of aGVHD was 22.17 d.The median time from the beginning of the clinical symptom to histopathological diagnosis was 7.5 d.All six cases underwent treatment of immunosuppressant adjustment,corticosteroids,human normal immunoglobulin,and antithymocyte globulin/IL-2 antagonists.Despite intensive treatment strategies,4 patients were deceased due to sepsis,multiple organ failure,and cerebral hemorrhage.The remaining two cases were discharged as treatment successfully.However,one died because of tuberculosis infection on the 6 th month of follow-up,the other one was alive healthy during 30 mo of follow-up.CONCLUSION The rapid diagnosis of aGVHD is mainly based on the time from the first symptom,histopathological features,and the donor T-lymphocyte chimerism.Our cases report highlights massive corticosteroid therapy and age difference between donors and recipients could accelerate to aGVHD.Moreover,gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.展开更多
Graft-verse-host disease (GVHD) is an uncommon fatal complication following liver transplantation (LTx). In China's Mainland, only six cases have been reported with a morbidity rate up to 1%-2%. Definitive diagnos...Graft-verse-host disease (GVHD) is an uncommon fatal complication following liver transplantation (LTx). In China's Mainland, only six cases have been reported with a morbidity rate up to 1%-2%. Definitive diagnosis was achieved by molecular techniques (HLA typing or PCR-STR) in only two cases and the remaining cases were diagnosed based on typical clinical features with exclusion of other possible causes. All patients died of septic shock or multiple organ failure even after administration of increased corticosteroids and supportive therapy, and reduced immunosuppressive agents. In our center, two cases of GVHD were found among 128 (1.56%) patients. One case was diagnosed by detecting lymphocyte macrochimerism through DNA-STR. Both of them died even after aggressive treatment. In China, the incidence of GVHD is similar to that reported by foreign centers except for an extremely bad prognosis. Rapid diagnosis is crucial for a better prognosis. In China, only 37.5% of cases are diagnosed by molecular methods. We recommend detecting lymphocyte macrochimerism through DNA-STR to get a rapid diagnosis, and interleukin 2-receptor antibody (basiliximab or daclizumab) therapy seems to be a good choice for the disease.展开更多
目的探讨老年无缺血肝移植患者的临床特点及护理侧重点。方法回顾性分析2017年7月至2022年12月在中山大学附属第一医院器官移植中心接受无缺血肝移植手术的107例终末期肝病患者的临床资料,其中30例年龄≥60岁的患者作为老年组,77例<6...目的探讨老年无缺血肝移植患者的临床特点及护理侧重点。方法回顾性分析2017年7月至2022年12月在中山大学附属第一医院器官移植中心接受无缺血肝移植手术的107例终末期肝病患者的临床资料,其中30例年龄≥60岁的患者作为老年组,77例<60岁作为对照组,比较两组受者各器官功能恢复及术后并发症情况。结果30例老年患者术后恢复顺利,两组术后原发性移植物无功能、早期移植物功能不全、胆道并发症、急性排斥反应和肠梗阻等并发症无统计学差异。两组术后肠道排气、胃管尿管留置、重症监护病房(intensive care unit,ICU)停留及住院时间方面与对照组也无统计学差异(P>0.05)。老年组术后肺部感染发生率明显高于对照组(P<0.05)。结论老年无缺血肝移植受者与年轻受者在临床康复过程尤其是肺部感染方面有一定差异,术前进行深呼吸、有效咳嗽、呼吸功能锻炼,术后强化早期下床活动,密切进行病情观察,遵医嘱使用抗菌药物,指导正确饮食加强营养,可降低肝移植后肺部感染的发生率。展开更多
目的探讨肝移植术后移植物抗宿主病(graft versus host d isease,GVHD)的护理方法。方法对6例发生GVHD的患者进行观察和护理。结果本组6例GVHD患者早期临床症状缺乏特异性,以不明原因发热和皮疹为首发症状,白细胞下降明显。4例因发生感...目的探讨肝移植术后移植物抗宿主病(graft versus host d isease,GVHD)的护理方法。方法对6例发生GVHD的患者进行观察和护理。结果本组6例GVHD患者早期临床症状缺乏特异性,以不明原因发热和皮疹为首发症状,白细胞下降明显。4例因发生感染、多器官功能衰竭、呼吸功能衰竭而死亡,2例痊愈出院。结论护理人员必须了解GVHD的临床特点,注意观察皮肤、消化道症状出现的时间,监测血象及肝功能的变化,做好感染的预防、用药的护理及心理护理,有助于提高GVHD的治愈率。展开更多
肝移植逐渐成为常规的治疗各种终末期肝病及肝功能衰竭唯一有效的治疗手段[1]。肝移植术后并发中枢神经系统脱髓鞘疾病（demyelinating diseases of central nervous system,DDCNS）是肝移植后常见的中枢神经系统并发症之一,发病率为8%~...肝移植逐渐成为常规的治疗各种终末期肝病及肝功能衰竭唯一有效的治疗手段[1]。肝移植术后并发中枢神经系统脱髓鞘疾病（demyelinating diseases of central nervous system,DDCNS）是肝移植后常见的中枢神经系统并发症之一,发病率为8%~10%。本病多为隐匿起病,发病原因复杂,治疗棘手,疗效不佳[2]。展开更多
基金Supported by The National Natural Science Foundation of China,No.81870445Scientific Research Project of Military Healthcare,No.BZZ19J004.
文摘BACKGROUND Graft-versus-host disease(GVHD)following liver transplantation(LT)is an unpredictable complication with poor outcome.However,consensus regarding the diagnosis and therapeutic regimen for the disease is yet lacking.The present study summarized the clinical experience on the diagnosis and treatment of acute GVHD(aGVHD)following LT and reviewed the pertinent literature.CASE SUMMARY Between January 1^(st),2000 and December 31^(st),2020,a total of 1053 LT were performed in the First Affiliated Hospital of Xi’an Jiaotong University.Six recipients developed aGVHD with clinical symptoms of fever,rash,diarrhea,and pancytopenia.The incidence of aGVHD was 0.57%.The median time from LT to the clinical presentation of aGVHD was 22.17 d.The median time from the beginning of the clinical symptom to histopathological diagnosis was 7.5 d.All six cases underwent treatment of immunosuppressant adjustment,corticosteroids,human normal immunoglobulin,and antithymocyte globulin/IL-2 antagonists.Despite intensive treatment strategies,4 patients were deceased due to sepsis,multiple organ failure,and cerebral hemorrhage.The remaining two cases were discharged as treatment successfully.However,one died because of tuberculosis infection on the 6 th month of follow-up,the other one was alive healthy during 30 mo of follow-up.CONCLUSION The rapid diagnosis of aGVHD is mainly based on the time from the first symptom,histopathological features,and the donor T-lymphocyte chimerism.Our cases report highlights massive corticosteroid therapy and age difference between donors and recipients could accelerate to aGVHD.Moreover,gut microbial interventions and donor-targeted serotherapy may provide novel therapeutics.
基金China Medical Board of New York Inc., No. 06-837Program for New Century Excellent Talents in Universities, No. NCET-04-0794
文摘Graft-verse-host disease (GVHD) is an uncommon fatal complication following liver transplantation (LTx). In China's Mainland, only six cases have been reported with a morbidity rate up to 1%-2%. Definitive diagnosis was achieved by molecular techniques (HLA typing or PCR-STR) in only two cases and the remaining cases were diagnosed based on typical clinical features with exclusion of other possible causes. All patients died of septic shock or multiple organ failure even after administration of increased corticosteroids and supportive therapy, and reduced immunosuppressive agents. In our center, two cases of GVHD were found among 128 (1.56%) patients. One case was diagnosed by detecting lymphocyte macrochimerism through DNA-STR. Both of them died even after aggressive treatment. In China, the incidence of GVHD is similar to that reported by foreign centers except for an extremely bad prognosis. Rapid diagnosis is crucial for a better prognosis. In China, only 37.5% of cases are diagnosed by molecular methods. We recommend detecting lymphocyte macrochimerism through DNA-STR to get a rapid diagnosis, and interleukin 2-receptor antibody (basiliximab or daclizumab) therapy seems to be a good choice for the disease.
文摘目的探讨老年无缺血肝移植患者的临床特点及护理侧重点。方法回顾性分析2017年7月至2022年12月在中山大学附属第一医院器官移植中心接受无缺血肝移植手术的107例终末期肝病患者的临床资料,其中30例年龄≥60岁的患者作为老年组,77例<60岁作为对照组,比较两组受者各器官功能恢复及术后并发症情况。结果30例老年患者术后恢复顺利,两组术后原发性移植物无功能、早期移植物功能不全、胆道并发症、急性排斥反应和肠梗阻等并发症无统计学差异。两组术后肠道排气、胃管尿管留置、重症监护病房(intensive care unit,ICU)停留及住院时间方面与对照组也无统计学差异(P>0.05)。老年组术后肺部感染发生率明显高于对照组(P<0.05)。结论老年无缺血肝移植受者与年轻受者在临床康复过程尤其是肺部感染方面有一定差异,术前进行深呼吸、有效咳嗽、呼吸功能锻炼,术后强化早期下床活动,密切进行病情观察,遵医嘱使用抗菌药物,指导正确饮食加强营养,可降低肝移植后肺部感染的发生率。
文摘目的探讨肝移植术后移植物抗宿主病(graft versus host d isease,GVHD)的护理方法。方法对6例发生GVHD的患者进行观察和护理。结果本组6例GVHD患者早期临床症状缺乏特异性,以不明原因发热和皮疹为首发症状,白细胞下降明显。4例因发生感染、多器官功能衰竭、呼吸功能衰竭而死亡,2例痊愈出院。结论护理人员必须了解GVHD的临床特点,注意观察皮肤、消化道症状出现的时间,监测血象及肝功能的变化,做好感染的预防、用药的护理及心理护理,有助于提高GVHD的治愈率。
文摘肝移植逐渐成为常规的治疗各种终末期肝病及肝功能衰竭唯一有效的治疗手段[1]。肝移植术后并发中枢神经系统脱髓鞘疾病（demyelinating diseases of central nervous system,DDCNS）是肝移植后常见的中枢神经系统并发症之一,发病率为8%~10%。本病多为隐匿起病,发病原因复杂,治疗棘手,疗效不佳[2]。
