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通过停用免疫抑制剂成功挽救肝移植术后急性移植物抗宿主病：一例报告

Successful salvage treatment of acute graft-versus-host disease after liver transplantation by withdrawal of immunosuppression: a case report.

作者信息

Qiu Wei, Lv Guo-Yue, Jiang Chao, Zhang Ping, Sun Xiao-Dong, Shi Xiao-Ju, Liu Xue-Yan, Wang Guang-Yi

机构信息

Department of Hepato-biliary Pancreatic Surgery, First Hospital of Jilin University, Changchun, China.

Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China.

出版信息

Korean J Hepatobiliary Pancreat Surg. 2016 Feb;20(1):38-43. doi: 10.14701/kjhbps.2016.20.1.38. Epub 2016 Feb 19.

DOI:10.14701/kjhbps.2016.20.1.38
PMID:26925149
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4767263/
Abstract

Acute graft-versus-host disease (GVHD) following liver transplantation is a rare but fatal complication. The correct diagnosis and management of GVHD after liver transplantation are still major challenges. Herein, we reported successful salvage treatment of acute GVHD by withdrawal of immunosuppression in a patient who presented with fever, skin rashes, and decreased blood cell counts after liver transplantation. This case highlights the need for awareness of drug-induced liver injury if liver function tests are elevated during treatment, especially in patients taking multiple potentially hepatotoxic drugs, such as broad-spectrum antibiotics. When occurs, an artificial liver support system is a useful tool to provide temporary support of liver function for the patient in the event of drug-induced liver injury.

摘要

肝移植后急性移植物抗宿主病（GVHD）是一种罕见但致命的并发症。肝移植后GVHD的正确诊断和管理仍然是重大挑战。在此，我们报告了1例肝移植后出现发热、皮疹和血细胞计数下降的患者，通过停用免疫抑制成功挽救治疗急性GVHD的病例。该病例强调，如果治疗期间肝功能检查升高，尤其是在服用多种潜在肝毒性药物（如广谱抗生素）的患者中，需要警惕药物性肝损伤。一旦发生药物性肝损伤，人工肝支持系统是为患者提供肝功能临时支持的有用工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/af51453d772d/kjhbps-20-38-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/40adfa9cfedf/kjhbps-20-38-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/b18755156f35/kjhbps-20-38-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/476ee1746e63/kjhbps-20-38-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/7a7ed239a2cb/kjhbps-20-38-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/af51453d772d/kjhbps-20-38-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/40adfa9cfedf/kjhbps-20-38-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/b18755156f35/kjhbps-20-38-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/476ee1746e63/kjhbps-20-38-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/7a7ed239a2cb/kjhbps-20-38-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9c86/4767263/af51453d772d/kjhbps-20-38-g005.jpg

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Acute graft versus host disease after orthotopic liver transplantation.原位肝移植后急性移植物抗宿主病。
J Hematol Oncol. 2012 Aug 13;5:50. doi: 10.1186/1756-8722-5-50.
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Unsuccessful treatment of four patients with acute graft-vs-host disease after liver transplantation.四例肝移植后急性移植物抗宿主病治疗失败的病例报告。
World J Gastroenterol. 2012 Jan 7;18(1):84-9. doi: 10.3748/wjg.v18.i1.84.
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The utility of fluorescence in situ hybridization (FISH) analysis in diagnosing graft versus host disease following orthotopic liver transplant.
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