Huang Lixin, Zhang Weiting, Fang Jiali, Jin Min, Zeng Lijuan, Deng Xuanying, Zhang Wanyi
Organ Transplantation Center, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Gland Surg. 2022 Apr;11(4):677-686. doi: 10.21037/gs-21-853.
This paper aimed to summarize our experience in the nursing of acute graft-versus-host disease (aGVHD) after simultaneous pancreas-kidney transplantation (SPK).
We retrospectively collected and analyzed the demographic characteristics, preoperative evaluation, donor evaluation, screening, and surgical methods of patients with aGVHD after SPK in our center from September 2016 to September 2019.
One patient developed intractable diarrhea with decline in platelet (PLT), white blood cell (WBC), and red blood cell (RBC) counts. Meanwhile, the other two patients experienced facial and trunk rashes, hepatic impairment, as well as decreased PLT, WBC, and RBC counts. We took the following nursing interventions: establishing an intensive care team and close monitoring of changes in the condition; protective isolation to minimize exogenous infections; nursing of pulmonary infections; and nutritional support. However, despite careful treatment and nursing, the conditions of the three patients subsequently worsened rapidly and became uncontrollable, and all died.
aGVHD is extremely rare after SPK, and no literature exists concerning nursing care or management related to this condition. Clinical manifestations and histopathology are helpful for diagnosis; however, treatment outcomes might be unsatisfactory and the prognosis is poor. Early detection, diagnosis, and intervention have a positive impact on the prognosis of aGVHD, and proper nursing can benefit patients.
本文旨在总结我们在胰肾联合移植（SPK）后急性移植物抗宿主病（aGVHD）护理方面的经验。
我们回顾性收集并分析了2016年9月至2019年9月在本中心接受SPK后发生aGVHD患者的人口统计学特征、术前评估、供体评估、筛查及手术方法。
1例患者出现顽固性腹泻，血小板（PLT）、白细胞（WBC）和红细胞（RBC）计数下降。同时，另外2例患者出现面部和躯干皮疹、肝功能损害以及PLT、WBC和RBC计数下降。我们采取了以下护理干预措施：组建重症护理团队并密切监测病情变化；保护性隔离以尽量减少外源性感染；肺部感染护理；以及营养支持。然而，尽管经过精心治疗和护理，这3例患者的病情随后迅速恶化且变得无法控制，最终均死亡。
SPK后aGVHD极为罕见，目前尚无关于该病护理或管理的文献。临床表现和组织病理学有助于诊断；然而，治疗效果可能不理想且预后较差。早期发现、诊断和干预对aGVHD的预后有积极影响，恰当的护理可使患者受益。
