Diagnosis and Treatment for Acute Graft Versus Host Disease after Liver Transplantation (Report of 2 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

李志伟 , 李超 , 马继韬 , 张睿 , 董权 , 梁爱君 , 王胤佳 , 周志刚

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Keywords：

肝移植; 移植物抗宿主疾病

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目的　探讨肝移植术后早期并发急性移植物抗宿主疾病(GVHD)的诊断和治疗。

方法　回顾性分析我院2006年5月至2007年10月期间行肝移植手术50例，其中2例术后并发GVHD，分析该2例肝移植术后第14 d和第18 d以出现不明原因发热、皮疹、口腔多发溃疡、全血细胞减少、皮肤病理活检等临床资料为诊断依据和以不同的免疫抑制剂治疗的方案。

结果　第1例患者加强免疫抑制剂治疗，发生败血症于术后67 d死于多器官功能衰竭；第2例减少免疫抑制剂治疗，术后96 d治愈。

结论　肝移植术后并发GVHD，减少免疫抑制剂方案可能是一种有效方案，但应警惕急性排斥反应和继发感染发生。

Citation： 李志伟,李超,马继韬,张睿,董权,梁爱君,王胤佳,周志刚. Diagnosis and Treatment for Acute Graft Versus Host Disease after Liver Transplantation (Report of 2 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2008, 15(9): 671-672. doi: Copy

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5.	Pollack MS, Speeg KV, Callander NS, et al. Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis [Ｊ]. Hum Immunol, 2005; 66(1)∶28.
6.	Meves A, el-Azhary RA, Talwalkar JA, et al. Acute graft-versus-host disease after liver transplantation diagnosed by fluorescent in situ hybridization testing of skin biopsy specimens [Ｊ]. J Am Acad Dermatol, 2006; 55(4)∶642.
7.	Wang B, Lu Y, Yu L, et al. Diagnosis and treatment for graft-versus-host disease after liver transplantation: two case reports [Ｊ]. Transplant Proc, 2007; 39(5)∶1696.
8.	高鹏骥，王东，朱继业，等. 肝移植术后移植物抗宿主病1例 [Ｊ]. 中华普通外科杂志， 2007； 22（4）∶308.
9.	Chinnakotla S, Smith DM, Domiati-Saad R, et al. Acute graft-versus-host disease after liver transplantation: role of withdrawal of immunosuppression in therapeutic management [Ｊ]. Liver Transpl, 2007; 13(1)∶157.
10.	周彦明，杨甲梅. 肝移植术后腹泻的相关病因及处理 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(2)∶155.

1. 　Smith DM, Agura E, Netto G, et al. Liver transplant-associated graft-versus-host disease [Ｊ]. Transplantation, 2003; 75(1)∶118.
2. 　Taylor AL, Gibbs P, Bradley JA. Acute graft versus host disease following liver transplantation: the enemy within [Ｊ]. Am J Transplant, 2004; 4(4)∶466.
3. 　Bettens F, Tiercy JM, Campanile N, et al. Microchimerism after liver transplantation: absence of rejection without abrogation of anti-donor cytotoxic T-lymphocyte-mediated alloreactivity [Ｊ]. Liver Transpl, 2005; 11(3)∶290.
4. 　Schppi MG, Belli DC, Rimensberger PC, et al. Fatal GvHD as a complication of liver transplantation for undetermined fulminant hepatic failure and associated aplastic anemia [Ｊ]. Liver Transpl, 2006; 12(11)∶1693.
5. 　Pollack MS, Speeg KV, Callander NS, et al. Severe, late-onset graft-versus-host disease in a liver transplant recipient documented by chimerism analysis [Ｊ]. Hum Immunol, 2005; 66(1)∶28.
6. 　Meves A, el-Azhary RA, Talwalkar JA, et al. Acute graft-versus-host disease after liver transplantation diagnosed by fluorescent in situ hybridization testing of skin biopsy specimens [Ｊ]. J Am Acad Dermatol, 2006; 55(4)∶642.
7. 　Wang B, Lu Y, Yu L, et al. Diagnosis and treatment for graft-versus-host disease after liver transplantation: two case reports [Ｊ]. Transplant Proc, 2007; 39(5)∶1696.
8. 　高鹏骥，王东，朱继业，等. 肝移植术后移植物抗宿主病1例 [Ｊ]. 中华普通外科杂志， 2007； 22（4）∶308.
9. 　Chinnakotla S, Smith DM, Domiati-Saad R, et al. Acute graft-versus-host disease after liver transplantation: role of withdrawal of immunosuppression in therapeutic management [Ｊ]. Liver Transpl, 2007; 13(1)∶157.
10. 　周彦明，杨甲梅. 肝移植术后腹泻的相关病因及处理 [Ｊ]. 中国普外基础与临床杂志， 2007； 14(2)∶155.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Diagnosis and Treatment for Acute Graft Versus Host Disease after Liver Transplantation (Report of 2 Cases)

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