Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases.
Diagnosis and treatment of acute graft-versus-host disease after liver transplantation: Report of six cases.
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肝移植术后急性移植物抗宿主病的诊治六例报告
DOI：
10.12998/wjcc.v9.i30.9255
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发表时间：
2021-10-26
影响因子：
1.1
通讯作者：
Hu LS
中科院分区：
文献类型：
--
作者：
Tian M;Lyu Y;Wang B;Liu C;Yu L;Shi JH;Liu XM;Zhang XG;Guo K;Li Y;Hu LS
背景：肝移植术后移植物抗宿主病（GVHD）是一种预后不良的不可预测的并发症。然而，关于该疾病的诊断和治疗方案尚未达成共识。本文总结了肝移植后急性移植物抗宿主病（aGVHD）的诊断和治疗经验，并复习了相关文献。病例总结自2000年1月1日至2020年12月31日，在Xi交通大学第一附属医院共进行了1053例LT。6例受者发生aGVHD，临床症状为发热、皮疹、腹泻和全血细胞减少。aGVHD发生率为0.57%。从LT到临床表现为aGVHD的中位时间为22.17 d。从出现临床症状到病理诊断的中位时间为7.5d。所有6例患者均接受了免疫抑制剂调整、皮质类固醇、人正常免疫球蛋白和抗胸腺细胞球蛋白/IL-2拮抗剂治疗。尽管采取了强化治疗策略，但仍有4例患者因败血症、多器官功能衰竭和脑出血死亡。其余2例患者治疗成功出院。其中1例在随访6个月时因结核感染死亡，另1例在随访30个月时仍健康存活。结论aGVHD的快速诊断主要依据发病时间、组织病理学特征和供者T淋巴细胞嵌合状态。我们的病例报告强调了大量皮质类固醇治疗和供体与受体之间的年龄差异可能加速aGVHD的发生。此外，肠道微生物干预和供体靶向血清疗法可能提供新的治疗方法。
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 1st, 2000 and December 31st, 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 6th 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.
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影响因子：
6.2
作者：
Murali AR;Chandra S;Stewart Z;Blazar BR;Farooq U;Ince MN;Dunkelberg J
通讯作者：
Dunkelberg J
影响因子：
8.8
作者：
Pahari, Hirak;Nagai, Shunji;Salgia, Reena
通讯作者：
Salgia, Reena
影响因子：
4.3
作者：
Chen, Xiao-Bo;Yang, Jie;Yan, Lu-Nan
通讯作者：
Yan, Lu-Nan
影响因子：
6.2
作者：
Taylor, AL;Gibbs, P;Taylor, CJ
通讯作者：
Taylor, CJ
影响因子：
3.6
作者：
Schulman JM;Yoon C;Schwarz J;Vagefi PA;Mully TW;Shinkai K
通讯作者：
Shinkai K