Chiba Tetsuhiro, Yokosuka Osamu, Goto Shigemasa, Fukai Kenichi, Imazeki Fumio, Kohno Yoichi, Nishimura Miki, Saito Yasushi, Saisho Hiromitsu
Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Japan.
Hepatogastroenterology. 2005 Nov-Dec;52(66):1849-53.
BACKGROUND/AIMS: Hepatic graft-versus-host disease (GVHD) is a frequent complication after bone marrow transplantation and often results in a fatal outcome. However, hepatic manifestation of chronic GVHD accompanied by unresolved acute GVHD has not been clarified so far. The present study was intended to examine clinicopathological features in patients in which acute GVHD appeared to progress gradually into chronic GVHD.
We evaluated laboratory data, pathological features and response to immunosuppression in 11 patients whose diseases were diagnosed as hepatic GVHD, retrospectively. The patients were classified into 3 groups: acute GVHD group (n=3), non-progressive chronic GVHD group (n=5) and progressive chronic GVHD group (n=3), which means continuous liver dysfunction beyond day 100 post-transplant.
Patients with progressive chronic GVHD showed higher peaks of aminotransferase and biliary tract enzyme levels than patients with acute GVHD and non-progressive chronic GVHD. Their biopsy specimens demonstrated severer changes in lobular parenchyma, portal area and small interlobular bile ducts. They also showed marked loss of bile ducts. Despite administration of prednisolone or dose escalation of cyclosporin A, their liver function tests did not return to normal within one year.
In cases of liver dysfunction that emerges within 100 days after transplantation, liver biopsy appears to be important to confirm diagnosis. Patients with acute hepatic GVHD need strong immunosuppression to prevent progression to chronic GVHD.
背景/目的：肝移植物抗宿主病（GVHD）是骨髓移植后常见的并发症，常导致致命后果。然而，慢性GVHD伴有未缓解的急性GVHD的肝脏表现至今尚未明确。本研究旨在探讨急性GVHD似乎逐渐进展为慢性GVHD患者的临床病理特征。
我们回顾性评估了11例被诊断为肝GVHD患者的实验室数据、病理特征及对免疫抑制的反应。患者分为3组：急性GVHD组（n = 3）、非进行性慢性GVHD组（n = 5）和进行性慢性GVHD组（n = 3），进行性慢性GVHD组指移植后100天仍存在持续肝功能障碍。
进行性慢性GVHD患者的转氨酶和胆道酶水平峰值高于急性GVHD和非进行性慢性GVHD患者。他们的活检标本显示小叶实质、门管区和小叶间小胆管有更严重的变化。还显示胆管明显缺失。尽管给予泼尼松龙或增加环孢素A剂量，他们的肝功能检查在一年内仍未恢复正常。
对于移植后100天内出现肝功能障碍的病例，肝活检对确诊似乎很重要。急性肝GVHD患者需要强效免疫抑制以防止进展为慢性GVHD。
