Yandza T, Schneider S M, Nishida S, Goubaux B, Badan L, Vanbiervliet G, Saint-Paul M C, Bernard G, Laffont C, Gari-Toussaint M, Girard-Pipau F, Miton V, Rahili A, Zeanandin G, Benchimol D, Tzakis A, Gugenheim J, Hébuterne X
Hôpital de l'Archet 2, Centre Hospitalo-Universitaire de Nice, Nice, France.
Transplant Proc. 2010 Jan-Feb;42(1):100-2. doi: 10.1016/j.transproceed.2009.12.023.
A 34-year-old-man with short-bowel syndrome received an isolated small bowel graft. On postoperative day (POD) 11, ileal biopsy specimen demonstrated mild to moderate rejection that did not respond to corticosteroid bolus therapy. On POD 14, endoscopy and histologic examination revealed exfoliative rejection that was not controlled after 14 days of therapy with thymoglobulin. On POD 95, the patient underwent surgery again because of intestinal obstruction. The graft was removed 6 months after transplantation because of continuous severe abdominal pain with weight loss. After enterectomy, the patient developed multiple-organ failure and died on POD day 8. This case underlines the severity of exfoliative rejection and suggests that early enterectomy be performed when the diagnosis is made, before deterioration of clinical status and development of infectious and nutritional complications.
一名患有短肠综合征的34岁男性接受了孤立性小肠移植。术后第11天，回肠活检标本显示轻度至中度排斥反应，对大剂量皮质类固醇治疗无反应。术后第14天，内镜检查和组织学检查显示为剥脱性排斥反应，使用抗胸腺细胞球蛋白治疗14天后仍未得到控制。术后第95天，患者因肠梗阻再次接受手术。由于持续严重腹痛伴体重减轻，移植6个月后切除了移植物。肠切除术后，患者出现多器官功能衰竭，于术后第8天死亡。该病例强调了剥脱性排斥反应的严重性，并表明在诊断明确后，在临床状况恶化以及出现感染和营养并发症之前应尽早进行肠切除术。
