Zhang Jiabin, Ren Bo, Hui Ren, Sun Yanling, Liu Zhenwen, Zhou Shaotang
Center of Hepatopancreaticobiliary Surgery and Liver Transplantation Anesthetic Department, 302 Hospital, Beijing, China.
Medicine (Baltimore). 2018 Aug;97(34):e12074. doi: 10.1097/MD.0000000000012074.
Severe aplastic anemia and its secondary comorbidities associated with human parvovirus B19 infection is a rare and sometimes refractory complication following liver transplantation.We retrospectively reviewed data for 217 adult liver transplant recipients from donations after death in China March 2013 through May 2017, 5 patients with human parvovirus B19 infectious diseases were teased out, and diagnoses were made from positive serological marker, bone marrow aspiration, and genome assay, other hemolytic causes were excluded. Severe aplastic anemia and its comorbidities were confirmed, combination of immunoglobulin and blood transfusion as well as immunosuppressant switch was employed for 5 recipients.Four male and 1 female recipients were diagnosed with human parvovirus B19 infections based on clinical presentations, bone marrow aspiration, and nested PCR, age ranged from 47 to 62 years, the onset time from liver transplantation varied from 29 to 415 days, anemia improved in 5 patients, 2 deaths occurred due to parvovirus-related morbidities, 1 patient died from de novo carcinoma of the tongue 2 years later and unrelated to parvovirus, 2 other recipients are still alive.Human parvovirus B19 infectious disease is a rare but clinically significant infection whose comorbidities will bring about more attentions.
严重再生障碍性贫血及其与人类细小病毒B19感染相关的继发性合并症是肝移植后一种罕见且有时难以治疗的并发症。我们回顾性分析了2013年3月至2017年5月在中国接受死后捐赠的217例成年肝移植受者的数据，筛选出5例人类细小病毒B19感染患者，通过血清学标志物阳性、骨髓穿刺和基因组检测进行诊断，排除其他溶血原因。确诊为严重再生障碍性贫血及其合并症后，对5例受者采用免疫球蛋白和输血联合以及免疫抑制剂转换的治疗方法。4例男性和1例女性受者根据临床表现、骨髓穿刺和巢式PCR诊断为人类细小病毒B19感染，年龄在47至62岁之间，肝移植后的发病时间为29至415天，5例患者贫血情况改善，2例因细小病毒相关疾病死亡，1例患者2年后死于舌部原发性癌，与细小病毒无关，另外2例受者仍存活。人类细小病毒B19感染性疾病是一种罕见但具有临床意义的感染，其合并症将引起更多关注。
