Kohata Katsura, Fujiwarw Tohru, Yamamoto Joji, Yamada Minami, Ishizawa Kenichi, Satoh Kazushige, Sekiguchi Satoshi, Kameoka Junichi, Satomi Susumu, Harigae Hideo
Department of Rheumatology and Hematology, Graduate School of Medicine, Tohoku University, Sendai, Japan.
Nihon Rinsho Meneki Gakkai Kaishi. 2010;33(1):20-3. doi: 10.2177/jsci.33.20.
A case of severe autoimmune hemolytic anemia after ABO matched living donor liver transplantation. We present here a case of severe autoimmune hemolytic anemia after ABO matched living donor liver transplantation. The patient is 56 y.o male. He received living donor liver transplantation from his ABO matched son in May 2007. In July, he was suffered from a progressive anemia, and diagnosed as autoimmune hemolytic anemia by the laboratory examinations. Intensive treatment including predonisolone, azathiopurine, rituximab, plasma exchange, was given, however, the disease was resistant to the treatment. By the administration of cyclophosphamide combined with rituximab, remission was finally achieved. To date, immune mediated hemolytic anemia after ABO matched living donor liver transplantation has not been reported, although several cases of ABO mismatched living donor liver transplantation have been reported. His severe but transient clinical course of anemia suggests that the transient emergence of donor lymphocytes may be responsible for onset of hemolytic anemia.
一例ABO血型匹配的活体供肝肝移植术后严重自身免疫性溶血性贫血病例。我们在此呈现一例ABO血型匹配的活体供肝肝移植术后严重自身免疫性溶血性贫血病例。患者为56岁男性。2007年5月，他接受了来自与其ABO血型匹配的儿子的活体供肝肝移植。7月，他出现进行性贫血，经实验室检查诊断为自身免疫性溶血性贫血。给予了包括泼尼松龙、硫唑嘌呤、利妥昔单抗、血浆置换在内的强化治疗，然而，该疾病对治疗耐药。通过环磷酰胺联合利妥昔单抗治疗，最终实现缓解。尽管已有数例ABO血型不匹配的活体供肝肝移植病例报道，但迄今为止，ABO血型匹配的活体供肝肝移植术后免疫介导的溶血性贫血尚未见报道。他严重但短暂的贫血临床病程提示，供体淋巴细胞的短暂出现可能是溶血性贫血发病的原因。
