Liver transplantation for severe hepatic graft-versus-host disease: An analysis of aggregate survival data
Liver transplantation for severe hepatic graft-versus-host disease: An analysis of aggregate survival data
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DOI：
10.1002/lt.20389
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发表时间：
2005-05-01
影响因子：
4.6
通讯作者：
Goss, JA
中科院分区：
文献类型：
--
作者：
Barshes, NR;Myers, GD;Goss, JA
移植物抗宿主病（GVHD）是骨髓移植后常见的并发症。移植物抗宿主病可能导致肝硬化或胆管的完全破坏，并且对于这种情况几乎没有有效的治疗选择。原位肝移植（奥尔特）已被描述为一种选择，但到目前为止，患者生存，移植物存活率和移植物抗宿主病复发率奥尔特后一直是未知的。移植物抗宿主病的原位肝奥尔特病例从几个来源积累：（1）在单一机构进行的奥尔特病例，（2）英语医学文献，（3）器官共享联合网络（UNOS）肝移植登记处。描述性数据来源于OLT前后的信息;生存分析采用Kaplan-Meier法。本文报告1例骨髓移植后移植物抗宿主病行原位肝移植，6例文献报道。肝外GVHD复发2例，无肝内GVHD复发。UNOS登记处包含另外73例因肝脏GVHD接受奥尔特的患者。1年和5年精算患者生存率分别为72.4%和62.9%。虽然4例患者需要再次移植，但没有死亡或再次移植归因于肝脏GVHD复发。奥尔特是治疗BMT或非肝脏器官移植后肝脏GVHD的有效方法。在这些病例中可获得长期无病生存，并且尚未报告肝脏GVHD复发。这些结果表明，奥尔特应被认为是一种有效的治疗选择的情况下，肝脏GVHD药物治疗无效。
Graft-versus-host disease (GVHD) often occurs after bone marrow transplantation (BMT). GVHD may lead to cirrhosis or complete destruction of the bile ducts, and few effective treatment options exist for such cases. Orthotopic liver transplantation (OLT) has been described as an option, but to date the patient survival, graft survival, and GVHD recurrence rates after OLT have been unknown. Cases of OLT for GVHD were accumulated from several sources: (1) cases of OLT performed at a single institution, (2) the English-language medical literature, and (3) the United Network for Organ Sharing (UNOS) liver transplant registry. Descriptive data were derived from pre-and post-OLT information; survival analysis was performed using the Kaplan-Meier method. One case of OLT for GVHD after BMT was found at our institution, and another 6 cases were previously reported in the literature. Extrahepatic GVHD recurred in 2 cases, but no recurrence of hepatic GVHD was reported. The UNOS registry contained an additional 73 patients who underwent OLT for hepatic GVHD. The 1- and 5-year actuarial patient survival rates were 72.4% and 62.9%, respectively. Although 4 patients required retransplantation, no deaths or retransplants were attributed to the recurrence of hepatic GVHD. OLT is an effective treatment for hepatic GVHD after BMT or non-liver organ transplant. Longterm disease-free survival is obtainable in these cases, and recurrence of hepatic GVHD has not been reported. These findings suggest that OLT should be considered as an effective treatment option for cases of hepatic GVHD recalcitrant to medical treatment.