Jiang Nan, Li Hua, Wang Gen-Shu, Zhang Jian, Zhang Jun-Feng, Yi Shu-Hong, Yang Yang, Cai Chang-Jie, Lu Min-Qiang, Chen Gui-Hua
Liver Transplant Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, NO.600 TianHe Road, TianHe District, Guangzhou 510630, Guangdong Province, PR China.
Leuk Res. 2009 Oct;33(10):1349-51. doi: 10.1016/j.leukres.2009.03.035. Epub 2009 May 15.
Little information is available about the risk factors and means to improve the survival rate of acute leukemia in a rare but often fatal complication after liver transplantation (LT). We report the development of AML-M2 in one of the 764 patients who underwent liver transplantation at our center, and review the literature on similar cases. The patient, a 42-year-old man who developed acute leukemia 38 months after liver transplantation, was successfully treated with chemotherapy and has subsequently been in remission. With appropriate adjustment of immunosuppressive agents, he was able to safely benefit from chemotherapy. Only 16 patients with acute leukemia after liver transplantation have been reported, and the mortality rate is extraordinarily high (52.94%, 9/17). More cases of acute leukemia will emerge as the rate of survival after liver transplantation increases. The patient's chromosomal mutation profile, the choice of immunosuppressive agent, and infection by hepatitis virus may be the risk factors for the development of acute leukemia after LT. Our experience suggests that clinicians should adjust the immunosuppressive agents according to the immunosuppressive state of the patient and explore the option of reducing or stopping the medication as long as liver function remains stable. These measures could help reduce the high mortality rate among these patients.
关于肝移植（LT）后一种罕见但往往致命的并发症——急性白血病的危险因素及提高其生存率的方法，目前可用信息较少。我们报告了在我们中心接受肝移植的764例患者中1例发生急性髓系白血病M2型的情况，并回顾了类似病例的文献。该患者为一名42岁男性，在肝移植后38个月发生急性白血病，经化疗成功治疗，随后一直处于缓解状态。通过适当调整免疫抑制剂，他能够安全地从化疗中获益。据报道，肝移植后发生急性白血病的患者仅有16例，死亡率极高（52.94%，9/17）。随着肝移植后生存率的提高，将会出现更多急性白血病病例。患者的染色体突变谱、免疫抑制剂的选择以及感染肝炎病毒可能是肝移植后发生急性白血病的危险因素。我们的经验表明，临床医生应根据患者的免疫抑制状态调整免疫抑制剂，并探索在肝功能保持稳定的情况下减少或停用药物的选择。这些措施有助于降低这些患者的高死亡率。
