Early graft loss secondary to massive hemorrhagic necrosis following orthotopic liver transplantation. Evidence for cytokine-mediated univisceral Shwartzman reaction.
Early graft loss secondary to massive hemorrhagic necrosis following orthotopic liver transplantation. Evidence for cytokine-mediated univisceral Shwartzman reaction.
复制标题
原位肝移植后继发大面积出血性坏死的早期移植物丢失。
DOI：
10.1097/00007890-199605150-00015
复制
发表时间：
1996
期刊：
影响因子：
6.2
通讯作者：
Tzakis,AG
中科院分区：
文献类型：
--
作者：
Burke,GW;Cirocco,R;Viciana,A;Ruiz,P;Markou,M;Allouch,M;Ciancio,G;Reddy,R;Jeffers,L;Schiff,E;Nery,J;Miller,J;Tzakis,AG
原位肝移植（奥尔特）后的肝脏大面积出血性坏死（MHN）很少发生在奥尔特后1周的恢复期。其特征是发热和移植物功能突然恶化，导致在没有血管血栓形成的情况下失败。病因尚不清楚，但通常在此之前有一定程度的同种异体移植排斥反应。奥尔特后6 ~ 8天，4例患者（共150例）出现发热、水肿，并在48小时内出现转氨酶快速升高。2例患者有轻度排斥反应的证据，另外2例有中度至重度急性细胞排斥反应。所有患者的ABO血型完全相同，交叉配型阴性。2例严重排斥反应患者先给予类固醇激素，后给予OKT 3。虽然怀疑败血症，抗生素治疗并没有改善临床过程。每例患者均进展为MHN，伴重度小叶中心坏死和可变的门静脉浸润。MHN患者血清IFN-γ和TNF-α水平在转氨酶升高之前即升高（分别为155±39 pg/ml和414±201 pg/ml），而严重排斥奥尔特患者血清IFN-γ和TNF-α水平分别为14±4 pg/ml和26±5 pg/ml，P< 0.05。这些数据支持了在移植的肝脏中，马槟榔碱介导的炎症反应导致单内脏Shwartzman反应的概念。早期识别这种综合征和再次移植是生存的关键。
Massive hemorrhagic necrosis (MHN) of the liver following orthotopic liver transplantation (OLT) occurs infrequently during an otherwise uneventful recovery 1 week after OLT. It is characterized by fever and sudden deterioration of allograft function leading to failure in the absence of vascular thrombosis. The etiology is unknown, although it is usually preceded by some degree of allograft rejection. Between 6 and 8 days after OLT, four patients (out of 150) became febrile, hypotensive, and experienced a rapid rise in transaminases within 48 hr. Two patients had evidence of mild rejection; the other two had moderate to severe acute cellular rejection. All patients were ABO identical, crossmatch negative. Bolus steroids were given followed by OKT3 in the two patients with severe rejection. Although sepsis was suspected, antibiotic therapy did not ameliorate the clinical course. Each patient progressed to MHN with severe centrilobular necrosis and variable portal infiltrate. High levels of interferon-γ and tumor necrosis factor-α occurred prior to the rise in transaminases in each MHN patient (155±39 pg/ml and 414±201 pg/ml, respectively) compared with levels in OLT patients with severe rejection (14±4 pg/ml and 26±5 pg/ml, respectively, P< 0.05). These data support the concept of a cytokine-mediated inflammatory response leading to a univisceral Shwartzman reaction in the transplanted liver. Early recognition of this syndrome and retransplantation are critical for survival.