Miloh Tamir, Arnon Ronen, Roman Elizabeth, Hurlet Anne, Kerkar Nanda, Wistinghausen Birte
Department of Gastroenterology, Phoenix Children's Hospital, Phoenix, AZ 85016, USA.
Pediatr Transplant. 2011 Dec;15(8):870-8. doi: 10.1111/j.1399-3046.2011.01596.x.
Cytopenias are common among pediatric SOT; however, autoimmune cytopenias are infrequently reported. We report five cases of autoimmune cytopenias in pediatric LT patients: two with isolated IgG-mediated AIHA, two with ITP, and one with Evans syndrome (ITP and AIHA). All patients were maintained on tacrolimus as immunosuppression. Viral illness commonly preceded the autoimmune cytopenias. All patients responded well to medical therapy (steroids, intravenous immunoglobulin, and rituximab) and lowering tacrolimus serum level. Prognosis appears to be worse when more than one cell line (e.g., Evans syndrome) is affected, and/or there is no preceding viral illness. A critical literature review of autoimmune cytopenias in children following SOT is conducted. Autoimmune cytopenias are a rarely reported complication of pediatric SOT, but clinicians taking care of pediatric transplant recipients need to be aware of this complication.
血细胞减少症在小儿实体器官移植受者中很常见；然而，自身免疫性血细胞减少症的报道却很少。我们报告了5例小儿肝移植患者的自身免疫性血细胞减少症病例：2例为孤立的IgG介导的自身免疫性溶血性贫血，2例为免疫性血小板减少症，1例为伊文氏综合征（免疫性血小板减少症和自身免疫性溶血性贫血）。所有患者均接受他克莫司作为免疫抑制治疗。自身免疫性血细胞减少症通常在病毒感染后出现。所有患者对药物治疗（类固醇、静脉注射免疫球蛋白和利妥昔单抗）以及降低他克莫司血清水平反应良好。当不止一种细胞系（如伊文氏综合征）受到影响和/或没有前驱病毒感染时，预后似乎更差。我们对小儿实体器官移植后儿童自身免疫性血细胞减少症进行了关键文献综述。自身免疫性血细胞减少症是小儿实体器官移植罕见的并发症，但照顾小儿移植受者的临床医生需要意识到这一并发症。
