肝移植术后移植物抗宿主病的诊断与治疗：两例报告
Diagnosis and treatment for graft-versus-host disease after liver transplantation: two case reports.
作者信息
Wang B, Lu Y, Yu L, Liu C, Wu Z, Liu X
机构信息
Department of Hepatobiliary Surgery, First Hospital of Xian Jiaotong University, 1 Jiankang Road, Xi'an, Shaanxi Province 710061, China.
出版信息
Transplant Proc. 2007 Jun;39(5):1696-8. doi: 10.1016/j.transproceed.2007.02.078.
AIM
The diagnosis and treatments were of 2 cases of graft-versus-host disease (GVHD) after liver transplantation are presented herein.
METHODS
The 2 cases were diagnosed at 24 and 32 days after liver transplantation, respectively. Fever, diarrhea, skin rash, and leukopenia were symptoms in both of them. They were treated with methylprednisolone (0.5 g/d, for 3 days), G-CSF, and GM-CSF. The dose of CsA was decreased in 1 of them.
RESULTS
One patient died of cerebral hemorrhage at 31 days after transplantation. The other 1 responded well to the methylprednisolone and the skin rash disappeared within 1 week after the treatment. He was discharged 50 days after transplantation.
CONCLUSION
Clinicians should be familiar with the risk factors, signs, and symptoms associated with GVHD after liver transplantation. Corticosteroids are the choice of treatment for GVHD after liver transplantation. Immunosuppressive agents should be decreased when GVHD is diagnosed.
目的
本文介绍2例肝移植后移植物抗宿主病（GVHD）的诊断及治疗情况。
方法
2例分别于肝移植后24天和32天确诊。二者均有发热、腹泻、皮疹及白细胞减少症状。给予甲泼尼龙（0.5g/d，共3天）、粒细胞集落刺激因子（G-CSF）及粒细胞巨噬细胞集落刺激因子（GM-CSF）治疗。其中1例减少了环孢素A（CsA）的剂量。
结果
1例患者于移植后31天死于脑出血。另1例对甲泼尼龙反应良好，治疗后1周内皮疹消失。移植后50天出院。
结论
临床医生应熟悉肝移植后GVHD的危险因素、体征及症状。糖皮质激素是肝移植后GVHD的治疗选择。诊断GVHD后应减少免疫抑制剂用量。
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