Asari Sadaki, Matsumoto Ippei, Toyama Hirochika, Shinzeki Makoto, Goto Tadahiro, Tanaka Masaki, Shirakawa Sachiyo, Yamashita Hironori, Ajiki Tetsuo, Fukumoto Takumi, Ku Yonson
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Department of Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012, Japan.
Surg Today. 2015 Dec;45(12):1567-71. doi: 10.1007/s00595-014-1069-z. Epub 2014 Nov 6.
Acute graft-versus-host-disease (aGVHD) is a rare complication in the setting of pancreas-kidney transplantation (PKT). We herein describe the case of a 37-year-old male with severe type 1 diabetes with chronic renal failure who received simultaneous PKT from a female donor. Diarrhea developed on postoperative day (POD) 10. Subsequently, fever and liver dysfunction occurred on POD 32. Skin rashes appeared with pain and itching on his trunk and extremities on POD 40. As pancytopenia occurred on POD 63, bone marrow biopsies demonstrated profound hypoplastic marrow. On POD 69, we eventually made a definitive diagnosis of aGVHD because skin biopsies revealed the XX chromosome signal in a fluorescence in situ hybridization analysis. Thereafter, 100 mg of prednisolone was administered for 5 days. Although every symptom was temporarily improved, on POD 156, the patient expired from the septic pneumonia without any effects of antibiotics. Clinician should be aware that PKT has the potential to induce aGVHD.
急性移植物抗宿主病（aGVHD）是胰肾联合移植（PKT）中一种罕见的并发症。我们在此描述一名37岁患有严重1型糖尿病合并慢性肾衰竭的男性患者，他接受了来自一名女性供体的同期PKT。术后第10天出现腹泻。随后，术后第32天出现发热和肝功能障碍。术后第40天，其躯干和四肢出现伴有疼痛和瘙痒的皮疹。术后第63天出现全血细胞减少，骨髓活检显示骨髓严重增生低下。术后第69天，由于皮肤活检在荧光原位杂交分析中显示XX染色体信号，我们最终确诊为aGVHD。此后，给予100mg泼尼松龙治疗5天。尽管所有症状暂时有所改善，但术后第156天，患者因脓毒症性肺炎死亡，抗生素治疗无效。临床医生应意识到PKT有诱发aGVHD的可能性。
