Smith Douglas M, Agura Edward, Netto George, Collins Robert, Levy Marlon, Goldstein Robert, Christensen Laura, Baker Judy, Altrabulsi Basel, Osowski Lori, McCormack Jeff, Fichtel Lisa, Dawson D Brian, Domiati-Saad Rana, Stone Marvin, Klintmalm Goran
Transplant Immunology Laboratory, Baylor University Medical Center, Dallas, TX, USA.
Transplantation. 2003 Jan 15;75(1):118-26. doi: 10.1097/00007890-200301150-00022.
Graft-versus-host disease (GVHD) is an important, underdiagnosed cause of mortality associated with liver transplantation. We identified 12 cases of GVHD among 1,082 liver transplantations performed in patients at our institution between 1991 and 1998. Patients typically developed fever, skin rash, diarrhea, or pancytopenia within 2 to 6 weeks after their transplant. Treatment generally involved increased immune suppression and hematopoietic cytokines (granulocyte colony stimulating factor, granulocyte monocyte colony stimulating factor); however, all but one patient died, most often from sepsis. Early in its course, GVHD was difficult to distinguish from cytomegalovirus disease or drug reactions. The diagnosis was confirmed by demonstration of substantial donor lymphoid chimerism.
To identify risk factors for severe GVHD, a retrospective analysis was performed comparing index cases with the rest of the cases in our institutional experience.
Closely matched human leukocyte antigen recipients, those older than 65 years, and recipients with donors more than 40 years younger were at higher risk for GVHD. One case occurred in a patient with a congenital immunodeficiency.
Liver transplant-associated GVHD is a progressive and fatal disease. Future approaches should focus on prevention and might include avoidance of closely matched human leukocyte antigen donors, treatment of the donor to reduce the number of lymphocytes, or reduction of immunosuppression in the early posttransplant period.
移植物抗宿主病（GVHD）是肝移植相关死亡的一个重要但诊断不足的原因。我们在1991年至1998年间于本机构为患者实施的1082例肝移植中识别出12例GVHD。患者通常在移植后2至6周内出现发热、皮疹、腹泻或全血细胞减少。治疗通常包括增加免疫抑制和使用造血细胞因子（粒细胞集落刺激因子、粒细胞-单核细胞集落刺激因子）；然而，除1例患者外均死亡，最常见的死因是败血症。在病程早期，GVHD很难与巨细胞病毒病或药物反应相区分。通过证实存在大量供体淋巴细胞嵌合体来确诊。
为识别严重GVHD的危险因素，进行了一项回顾性分析，将索引病例与我们机构经验中的其他病例进行比较。
人类白细胞抗原配型紧密的受者、65岁以上的受者以及供体比其年轻40岁以上的受者发生GVHD的风险更高。1例发生在一名先天性免疫缺陷患者身上。
肝移植相关GVHD是一种进行性致命疾病。未来的方法应侧重于预防，可能包括避免使用人类白细胞抗原配型紧密的供体、对供体进行处理以减少淋巴细胞数量，或在移植后早期减少免疫抑制。
